VistApedia - User contributions [en]

Meaningful Use Stage One Final Rule

2011-03-08T17:50:36Z

Peterbodtke: /* Meaningful Use - Core Set (15) */

Core Set (15) and Menu Set (pick 5 of 10, include one population/public health measure) requirements

===Meaningful Use - Core Set (15)===

1. Record patient demographics (sex, race, ethnicity, date of birth, preferred language, and in the case of hospitals, date and preliminary cause of death in the event of mortality). More than 50% of patients' demographic data must be recorded as structured data 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(c)-Record Demographics 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Record_Demographics_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(b)-Record Demographics 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Record_Demographics_%28EH/CAH%29

2. Record vital signs and chart changes (height, weight, blood pressure, body mass index, growth charts for children). More than 50% of patients 2 years of age or older must have height, weight and blood pressure recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(e)-Record and Chart Vital Signs 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Record_and_Chart_Vital_Signs

3. Maintain up-to-date problem list of current and active diagnoses. More than 80% of patients must have at least one entry recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(b)-Maintain Up-To- Date Problem List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Maintain_Up-To-_Date_Problem_List

4. Maintain an active medication list. More than 80% of patients have at least one entry recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(c)-Maintain Active Medication List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Maintain_Active_Medication_List

5. Maintain an active medication allergy list. More than 80% of patients have at least one entry recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(d)-Maintain Active Medication Allergy List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Maintain_Active_Medication_Allergy_List

6. Record smoking status for patients 13 and older. More than 50% if patients age 13 or older have smoking status recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(g)-Smoking Status 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Smoking_Status

7. For professionals, provide patients with clinical summaries for each office visit; for hospitals provide an electronic copy of hospital discharge instructions upon request. Clinical summaries provided to patients for more than 50% of all visits within 3 business days. More than 50% of all patients who are discharged from an inpatient or ED of a hospital who request an electronic copy of their discharge instructions must be provided with it. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(h)-Clinical Summaries 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Clinical_Summaries 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(e)-Electronic Copy of Discharge Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronic_Copy_of_Discharge_Information_%28EH/CAH%29

8. Upon request, provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication list, medication allergies, and for hospitals discharge summary and procedures). More than 50% of requesting patients must receive an electronic copy within 3 business days. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(f)-Electronic Copy of Health Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronic_Copy_of_Health_Information_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(d)-Electronic Copy of Health Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronic_Copy_of_Health_Information_%28EH/CAH%29

9. Generate and transmit permissible prescriptions electronically (does not apply to hospitals). More than 40% must be transmitted electronically using certified EHR technology. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(b)-Electronically Exchange Prescription Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronically_Exchange_Prescription_Information

10. Computerized Provider Order Entry for Medication Orders. More than 30% of patients with at least one medication in their medication list must have at least one medication ordered through CPOE 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(a)-Computerized Provider Order Entry 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Computerized_Provider_Order_Entry_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(a)-Computerized Provider Order Entry 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Computerized_Provider_Order_Entry_%28EH/CAH%29

11. Implement drug-drug and drug-allergy interaction checks. Functionality must be enabled for these checks for the entire reporting period. 

:'''Criteria for: All Users''' 
:Section 170.302(a)-Drug-Drug, Drug-Allergy, Drug-Formulary Checks 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Drug-Drug_Drug-Allergy_Checks

12. Implement capability to electronically exchange key clinical information among providers and patient-authorized entities. Must perform at least one test of the EHR's capacity to electronically exchange information. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(i)-Exchange Clinical Information and Patient Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Capability_To_Exchange_Key_Clinical_Information_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(f)-Exchange Clinical Information and Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Capability_To_Exchange_Key_Clinical_Information_%28EH/CAH%29

13. Implement one clinical decision support rule and track compliance with that rule. One rule must be implemented. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(e)-Clinical Decision Support 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Clinical_Decision_Support_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(c)-Clinical Decision Support 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Clinical_Decision_Support_%28EH/CAH%29

14. Implement systems to protect privacy and security of patient data in the EHR. Must conduct or review a security risk analysis, implement security updates as necessary and correct identified security deficiencies. 

:'''Criteria for: All Users''' 
:Section 170.302(o)-Access Control 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Access_Control 

:'''Criteria for: All Users''' 
:Section 170.302(p)-Emergency Access 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Emergency_Access 

:'''Criteria for: All Users''' 
:Section 170.302(q)-Automatic Log-Off 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Automatic_Log-Off 

:'''Criteria for: All Users''' 
:Section 170.302(r)-Audit Log 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Audit_Log 

:'''Criteria for: All Users''' 
:Section 170.302(s)-Integrity 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Integrity 

:'''Criteria for: All Users''' 
:Section 170.302(t)-Authentication 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Authentication 

:'''Criteria for: All Users''' 
:Section 170.302(u)-Encryption 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Encryption

15. Report Clinical Quality Measures to CMS or the states. For 2011 provide aggregate numerator and denominator through attestation. For 2012, electronically submit measures. 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.302(i)-Report Quality Measures 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Report_Quality_Measures_%28EH/CAH%29 

:'''Criteria for: Eligible Professionals''' 
:Section 170.302(i)-Report Quality Measures 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Report_Quality_Measures_%28EP%29

===Meaningful Use - Menu Set (Pick 5 of 10) ===

1. Implement drug formulary checks. Drug formulary check system must be implemented and access at least one internal or external drug formulary during the reporting period. 

:'''Criteria for: All Users''' 
:Section 170.302(a)-Drug-Drug, Drug-Allergy, Drug-Formulary Checks 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Drug-Formulary_Checks

2. Incorporate clinical laboratory test results into EHRs as structured data. More than 40% of clinical laboratory test results are in positive/negative or numerical format and are incorporated into EHRs as structured data 

:'''Criteria for: All Users''' 
:Section 170.302(g)-Incorporate Laboratory Test Results 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Incorporate_Laboratory_Test_Results

3. Generate lists of patients by specific conditions for use for quality improvement, reduction of disparities, research or outreach. Must generate one listing of patients with a specific condition 

:'''Criteria for: All Users''' 
:Section 170.302(h)-Generate Patient Lists 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Generate_Patient_Lists

4. Use EHR technology to identify patient-specific education resources and provide those to the patient as appropriate. More than 10% of patients are provided patient specific education resources 

:'''Criteria for: All Users''' 
:Section N/A - Patient-specific Education Resources 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Patient-specific_Education_Resources

5. Perform Medication reconciliation between care settings. Medication reconciliation must be performed for more than 50% of transitions of care. 

:'''Criteria for: All Users''' 
:Section 170.302(l)-Medication Reconciliation 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Medication_Reconciliation

6. Provide summary of care record for patients referred or transitioned to another provider or setting. Summary of care record must be provided for more than 50% of patient transitions or referrals 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(i)-Exchange Clinical Information and Patient Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Provide_Summary_Of_Care_Record_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(f)-Exchange Clinical Information and Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Provide_Summary_Of_Care_Record_%28EH/CAH%29

7. Submission of electronic immunization data to immunization registries or immunization information systems. Must perform at least one test of data submission and follow-up submission (where registries can accept electronic submissions) 

:'''Criteria for: All Users''' 
:Section 170.302(m)-Submission to Immunization Registries 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Submission_to_Immunization_Registries

8. Submission of electronic syndromic surveillance data to public health agencies. Must perform at least one test of data submission and xe submission (where public health agencies can accept electronic data) 

:'''Criteria for: All Users''' 
:Section 170.302(n)-Public Health Surveillance 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Public_Health_Surveillance 
====For hospitals - 9 & 10====

9. Record advanced directives for patients 65 years or older. More than 50% of patients aged 65 or older must have an indication of an advanced directive status recorded. 

:'''Criteria for: Eligible Hospitals and CAHs''' 
Section N/A - Advance Directives 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Advance_Directives

10. Submission of electronic data on reportable laboratory results to public health agencies. Perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic data) 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(g)-Reportable Lab Results 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Reportable_Lab_Results_%28EH/CAH%29 
====For professionals - 9 & 10====

9. Send reminders to patients (per patient preference) for preventative and follow-up care. More than 20% of patients aged 65 or older or age 5 or younger must be sent appropriate reminders. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(d)-Generate Patient Reminder List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Generate_Patient_Reminder_List

10. Provide patients with timely electronic access to their health information (including laboratory results, problem list, medication list, medication allergies). More than 10% of patients must be provided with electronic access to information within 4 days of its being updated in the EHR. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(g)-Timely Access 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Timely_Access 
===Meaningful Use Data Exchanges===

====Core Set====
1. Provide patients an electronic copy of their ambulatory, ED or inpatient summary of care record record 
2. Transmit prescriptions 
3. Capability to exchange key clinical information among care providers and patient authorized entities 
4. Report clinical quality measures 
====Menu Set ====
5. Incorporate clinical lab tests results into EHRs as structured data 
6. Provide summary of care record for patients referred or transition to another provider or setting 
7. Capability to submit data to immunization registries, provide syndromic surveillance and lab data to public health agencies 
Another issue not in this PPT: 
The date, time, patient identification, and user identification must be recorded when electronic health information is created, modified, accessed, or deleted; and an indication of which action(s) occurred and by whom must also be recorded 

===Approved Test Procedures===
Each wiki pages described on this page contains a link to the NIST testing requirement specific to meaningful use criteria. 
Below is a link to the NIST page that lists all of the test procedure documents on one page: 
http://healthcare.nist.gov/use_testing/effective_requirements.html (updated to reflect V1.1 and v1.2 documents)

MU Stage1 Final Rule - Submission to Immunization Registries

2011-02-01T03:56:23Z

Peterbodtke:

'''SECTION # '''
Section 170.302(m)—Submission to Immunization Registries

'''MU OBJECTIVE'''
Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice

'''MU STAGE 1 MEASURE'''
Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP, eligible hospital or CAH submits such information have the capacity to receive the information electronically).

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.302(k).
Submission to immunization registries. Electronically record, modify, retrieve, and submit immunization information in accordance with:
(1) The standard (and applicable implementation specifications) specified in §170.205(e)(1) or §170.205(e)(2); and
(2) At a minimum, the version of the standard specified in §170.207(e).

'''STANDARDS'''
§170.205(e)(1)
§170.205(e)(2)
§170.207(e)

'''TEST CRITERIA #'''
§170.302 (k)
http://healthcare.nist.gov/docs/170.302.k_Immunizations_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| MENU
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''

Standards details -
§170.205(e)(1)

(e) Electronically exchange quality reporting information. The Secretary adopts the following content exchange standard and implementation specification for quality reporting.
(1) Standard. The CMS Physician Quality Reporting Initiative (PQRI) 2008 Registry XML Specification (incorporated by reference in §170.299).

-or-

§170.205(e)(2);

(2) Implementation specification. Physician Quality Reporting Initiative Measure Specifications Manual for Claims and Registry (incorporated by reference in §170.299).

-and-

At a minimum, the version of the standard specified in §170.207(e).

(e) Immunizations. Standard. HL7 Standard Code Set CVX - Vaccines Administered, July 30, 2009 version (incorporated by reference in §170.299).

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

Meaningful Use Stage One Final Rule

2011-02-01T02:22:15Z

Peterbodtke:

Core Set (15) and Menu Set (pick 5 of 10, include one population/public health measure) requirements

===Meaningful Use - Core Set (15)===

1. Record patient demographics (sex, race, ethnicity, date of birth, preferred language, and in the case of hospitals, date and preliminary cause of death in the event of mortality). More than 50% of patients' demographic data must be recorded as structured data 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(c)-Record Demographics 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Record_Demographics_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(b)-Record Demographics 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Record_Demographics_%28EH/CAH%29

2. Record vital signs and chart changes (height, weight, blood pressure, body mass index, growth charts for children). More than 50% of patients 2 years of age or older must have height, weight and blood pressure recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(e)-Record and Chart Vital Signs 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Record_and_Chart_Vital_Signs

3. Maintain up-to-date problem list of current and active diagnoses. More than 80% of patients must have at least one entry recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(b)-Maintain Up-To- Date Problem List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Maintain_Up-To-_Date_Problem_List

4. Maintain an active medication list. More than 80% of patients have at least one entry recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(c)-Maintain Active Medication List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Maintain_Active_Medication_List

5. Maintain an active medication allergy list. More than 80% of patients have at least one entry recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(d)-Maintain Active Medication Allergy List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Maintain_Active_Medication_Allergy_List

6. Record smoking status for patients 13 and older. More than 50% if patients age 13 or older have smoking status recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(f)-Smoking Status 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Smoking_Status

7. For professionals, provide patients with clinical summaries for each office visit; for hospitals provide an electronic copy of hospital discharge instructions upon request. Clinical summaries provided to patients for more than 50% of all visits within 3 business days. More than 50% of all patients who are discharged from an inpatient or ED of a hospital who request an electronic copy of their discharge instructions must be provided with it. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(h)-Clinical Summaries 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Clinical_Summaries 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(e)-Electronic Copy of Discharge Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronic_Copy_of_Discharge_Information_%28EH/CAH%29

8. Upon request, provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication list, medication allergies, and for hospitals discharge summary and procedures). More than 50% of requesting patients must receive an electronic copy within 3 business days. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(f)-Electronic Copy of Health Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronic_Copy_of_Health_Information_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(d)-Electronic Copy of Health Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronic_Copy_of_Health_Information_%28EH/CAH%29

9. Generate and transmit permissible prescriptions electronically (does not apply to hospitals). More than 40% must be transmitted electronically using certified EHR technology. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(b)-Electronically Exchange Prescription Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronically_Exchange_Prescription_Information

10. Computerized Provider Order Entry for Medication Orders. More than 30% of patients with at least one medication in their medication list must have at least one medication ordered through CPOE 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(a)-Computerized Provider Order Entry 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Computerized_Provider_Order_Entry_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(a)-Computerized Provider Order Entry 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Computerized_Provider_Order_Entry_%28EH/CAH%29

11. Implement drug-drug and drug-allergy interaction checks. Functionality must be enabled for these checks for the entire reporting period. 

:'''Criteria for: All Users''' 
:Section 170.302(a)-Drug-Drug, Drug-Allergy, Drug-Formulary Checks 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Drug-Drug_Drug-Allergy_Checks

12. Implement capability to electronically exchange key clinical information among providers and patient-authorized entities. Must perform at least one test of the EHR's capacity to electronically exchange information. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(i)-Exchange Clinical Information and Patient Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Capability_To_Exchange_Key_Clinical_Information_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(f)-Exchange Clinical Information and Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Capability_To_Exchange_Key_Clinical_Information_%28EH/CAH%29

13. Implement one clinical decision support rule and track compliance with that rule. One rule must be implemented. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(e)-Clinical Decision Support 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Clinical_Decision_Support_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(c)-Clinical Decision Support 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Clinical_Decision_Support_%28EH/CAH%29

14. Implement systems to protect privacy and security of patient data in the EHR. Must conduct or review a security risk analysis, implement security updates as necessary and correct identified security deficiencies. 

:'''Criteria for: All Users''' 
:Section 170.302(o)-Access Control 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Access_Control 

:'''Criteria for: All Users''' 
:Section 170.302(p)-Emergency Access 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Emergency_Access 

:'''Criteria for: All Users''' 
:Section 170.302(q)-Automatic Log-Off 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Automatic_Log-Off 

:'''Criteria for: All Users''' 
:Section 170.302(r)-Audit Log 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Audit_Log 

:'''Criteria for: All Users''' 
:Section 170.302(s)-Integrity 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Integrity 

:'''Criteria for: All Users''' 
:Section 170.302(t)-Authentication 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Authentication 

:'''Criteria for: All Users''' 
:Section 170.302(u)-Encryption 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Encryption

15. Report Clinical Quality Measures to CMS or the states. For 2011 provide aggregate numerator and denominator through attestation. For 2012, electronically submit measures. 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.302(i)-Report Quality Measures 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Report_Quality_Measures_%28EH/CAH%29 

:'''Criteria for: Eligible Professionals''' 
:Section 170.302(i)-Report Quality Measures 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Report_Quality_Measures_%28EP%29

===Meaningful Use - Menu Set (Pick 5 of 10) ===

1. Implement drug formulary checks. Drug formulary check system must be implemented and access at least one internal or external drug formulary during the reporting period. 

:'''Criteria for: All Users''' 
:Section 170.302(a)-Drug-Drug, Drug-Allergy, Drug-Formulary Checks 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Drug-Formulary_Checks

2. Incorporate clinical laboratory test results into EHRs as structured data. More than 40% of clinical laboratory test results are in positive/negative or numerical format and are incorporated into EHRs as structured data 

:'''Criteria for: All Users''' 
:Section 170.302(g)-Incorporate Laboratory Test Results 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Incorporate_Laboratory_Test_Results

3. Generate lists of patients by specific conditions for use for quality improvement, reduction of disparities, research or outreach. Must generate one listing of patients with a specific condition 

:'''Criteria for: All Users''' 
:Section 170.302(h)-Generate Patient Lists 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Generate_Patient_Lists

4. Use EHR technology to identify patient-specific education resources and provide those to the patient as appropriate. More than 10% of patients are provided patient specific education resources 

:'''Criteria for: All Users''' 
:Section N/A - Patient-specific Education Resources 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Patient-specific_Education_Resources

5. Perform Medication reconciliation between care settings. Medication reconciliation must be performed for more than 50% of transitions of care. 

:'''Criteria for: All Users''' 
:Section 170.302(l)-Medication Reconciliation 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Medication_Reconciliation

6. Provide summary of care record for patients referred or transitioned to another provider or setting. Summary of care record must be provided for more than 50% of patient transitions or referrals 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(i)-Exchange Clinical Information and Patient Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Provide_Summary_Of_Care_Record_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(f)-Exchange Clinical Information and Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Provide_Summary_Of_Care_Record_%28EH/CAH%29

7. Submission of electronic immunization data to immunization registries or immunization information systems. Must perform at least one test of data submission and follow-up submission (where registries can accept electronic submissions) 

:'''Criteria for: All Users''' 
:Section 170.302(m)-Submission to Immunization Registries 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Submission_to_Immunization_Registries

8. Submission of electronic syndromic surveillance data to public health agencies. Must perform at least one test of data submission and xe submission (where public health agencies can accept electronic data) 

:'''Criteria for: All Users''' 
:Section 170.302(n)-Public Health Surveillance 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Public_Health_Surveillance 
====For hospitals - 9 & 10====

9. Record advanced directives for patients 65 years or older. More than 50% of patients aged 65 or older must have an indication of an advanced directive status recorded. 

:'''Criteria for: Eligible Hospitals and CAHs''' 
Section N/A - Advance Directives 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Advance_Directives

10. Submission of electronic data on reportable laboratory results to public health agencies. Perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic data) 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(g)-Reportable Lab Results 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Reportable_Lab_Results_%28EH/CAH%29 
====For professionals - 9 & 10====

9. Send reminders to patients (per patient preference) for preventative and follow-up care. More than 20% of patients aged 65 or older or age 5 or younger must be sent appropriate reminders. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(d)-Generate Patient Reminder List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Generate_Patient_Reminder_List

10. Provide patients with timely electronic access to their health information (including laboratory results, problem list, medication list, medication allergies). More than 10% of patients must be provided with electronic access to information within 4 days of its being updated in the EHR. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(g)-Timely Access 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Timely_Access 
===Meaningful Use Data Exchanges===

====Core Set====
1. Provide patients an electronic copy of their ambulatory, ED or inpatient summary of care record record 
2. Transmit prescriptions 
3. Capability to exchange key clinical information among care providers and patient authorized entities 
4. Report clinical quality measures 
====Menu Set ====
5. Incorporate clinical lab tests results into EHRs as structured data 
6. Provide summary of care record for patients referred or transition to another provider or setting 
7. Capability to submit data to immunization registries, provide syndromic surveillance and lab data to public health agencies 
Another issue not in this PPT: 
The date, time, patient identification, and user identification must be recorded when electronic health information is created, modified, accessed, or deleted; and an indication of which action(s) occurred and by whom must also be recorded 

===Approved Test Procedures===
Each wiki pages described on this page contains a link to the NIST testing requirement specific to meaningful use criteria. 
Below is a link to the NIST page that lists all of the test procedure documents on one page: 
http://healthcare.nist.gov/use_testing/effective_requirements.html (updated to reflect V1.1 and v1.2 documents)

MU Stage1 Final Rule - Public Health Surveillance

2011-02-01T02:17:55Z

Peterbodtke: updated test script version to v1.2

'''SECTION # '''
Section 170.302(n)—Public Health Surveillance

'''MU OBJECTIVE'''
Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice.

'''MU STAGE 1 MEASURE'''
Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP, el

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.302(l).
Public health surveillance. Electronically record, modify, retrieve, and submit syndrome-based public health surveillance information in accordance with the standard (and applicable implementation specifications) specified in §170.205(d)(1) or §170.205(d)(2).

'''STANDARDS'''
§170.205(d)(1)
§170.205(d)(2)

'''TEST CRITERIA #'''
§170.302(l)
http://healthcare.nist.gov/docs/170.302.l_PublicHealthSurveillance_v1.2.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| MENU
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Submission to Immunization Registries

2010-12-21T03:03:05Z

Peterbodtke: Corrected truncated passage in Stage 1 Measure section

'''SECTION # '''
Section 170.302(m)—Submission to Immunization Registries

'''MU OBJECTIVE'''
Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice

'''MU STAGE 1 MEASURE'''
Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP, eligible hospital or CAH submits such information have the capacity to receive the information electronically).

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.302(k).
Submission to immunization registries. Electronically record, modify, retrieve, and submit immunization information in accordance with:
(1) The standard (and applicable implementation specifications) specified in §170.205(e)(1) or §170.205(e)(2); and
(2) At a minimum, the version of the standard specified in §170.207(e).

'''STANDARDS'''
§170.205(e)(1)
§170.205(e)(2)
§170.207(e)

'''TEST CRITERIA #'''
§170.302 (k)
http://healthcare.nist.gov/docs/170.302.k_Immunizations_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| MENU
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Electronic Copy of Health Information (EH/CAH)

2010-12-13T05:52:05Z

Peterbodtke: gap analysis removed

Meaningful Use Stage One Final Rule

2010-12-12T19:48:15Z

Peterbodtke: link to gap analysis removed

Core Set (15) and Menu Set (pick 5 of 10, include one population/public health measure) requirements

===Meaningful Use - Core Set (15)===

1. Record patient demographics (sex, race, ethnicity, date of birth, preferred language, and in the case of hospitals, date and preliminary cause of death in the event of mortality). More than 50% of patients' demographic data must be recorded as structured data 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(c)-Record Demographics 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Record_Demographics_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(b)-Record Demographics 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Record_Demographics_%28EH/CAH%29

2. Record vital signs and chart changes (height, weight, blood pressure, body mass index, growth charts for children). More than 50% of patients 2 years of age or older must have height, weight and blood pressure recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(e)-Record and Chart Vital Signs 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Record_and_Chart_Vital_Signs

3. Maintain up-to-date problem list of current and active diagnoses. More than 80% of patients must have at least one entry recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(b)-Maintain Up-To- Date Problem List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Maintain_Up-To-_Date_Problem_List

4. Maintain an active medication list. More than 80% of patients have at least one entry recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(c)-Maintain Active Medication List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Maintain_Active_Medication_List

5. Maintain an active medication allergy list. More than 80% of patients have at least one entry recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(d)-Maintain Active Medication Allergy List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Maintain_Active_Medication_Allergy_List

6. Record smoking status for patients 13 and older. More than 50% if patients age 13 or older have smoking status recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(f)-Smoking Status 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Smoking_Status

7. For professionals, provide patients with clinical summaries for each office visit; for hospitals provide an electronic copy of hospital discharge instructions upon request. Clinical summaries provided to patients for more than 50% of all visits within 3 business days. More than 50% of all patients who are discharged from an inpatient or ED of a hospital who request an electronic copy of their discharge instructions must be provided with it. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(h)-Clinical Summaries 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Clinical_Summaries 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(e)-Electronic Copy of Discharge Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronic_Copy_of_Discharge_Information_%28EH/CAH%29

8. Upon request, provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication list, medication allergies, and for hospitals discharge summary and procedures). More than 50% of requesting patients must receive an electronic copy within 3 business days. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(f)-Electronic Copy of Health Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronic_Copy_of_Health_Information_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(d)-Electronic Copy of Health Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronic_Copy_of_Health_Information_%28EH/CAH%29

9. Generate and transmit permissible prescriptions electronically (does not apply to hospitals). More than 40% must be transmitted electronically using certified EHR technology. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(b)-Electronically Exchange Prescription Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronically_Exchange_Prescription_Information

10. Computerized Provider Order Entry for Medication Orders. More than 30% of patients with at least one medication in their medication list must have at least one medication ordered through CPOE 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(a)-Computerized Provider Order Entry 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Computerized_Provider_Order_Entry_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(a)-Computerized Provider Order Entry 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Computerized_Provider_Order_Entry_%28EH/CAH%29

11. Implement drug-drug and drug-allergy interaction checks. Functionality must be enabled for these checks for the entire reporting period. 

:'''Criteria for: All Users''' 
:Section 170.302(a)-Drug-Drug, Drug-Allergy, Drug-Formulary Checks 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Drug-Drug_Drug-Allergy_Checks

12. Implement capability to electronically exchange key clinical information among providers and patient-authorized entities. Must perform at least one test of the EHR's capacity to electronically exchange information. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(i)-Exchange Clinical Information and Patient Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Capability_To_Exchange_Key_Clinical_Information_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(f)-Exchange Clinical Information and Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Capability_To_Exchange_Key_Clinical_Information_%28EH/CAH%29

13. Implement one clinical decision support rule and track compliance with that rule. One rule must be implemented. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(e)-Clinical Decision Support 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Clinical_Decision_Support_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(c)-Clinical Decision Support 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Clinical_Decision_Support_%28EH/CAH%29

14. Implement systems to protect privacy and security of patient data in the EHR. Must conduct or review a security risk analysis, implement security updates as necessary and correct identified security deficiencies. 

:'''Criteria for: All Users''' 
:Section 170.302(o)-Access Control 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Access_Control 

:'''Criteria for: All Users''' 
:Section 170.302(p)-Emergency Access 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Emergency_Access 

:'''Criteria for: All Users''' 
:Section 170.302(q)-Automatic Log-Off 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Automatic_Log-Off 

:'''Criteria for: All Users''' 
:Section 170.302(r)-Audit Log 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Audit_Log 

:'''Criteria for: All Users''' 
:Section 170.302(s)-Integrity 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Integrity 

:'''Criteria for: All Users''' 
:Section 170.302(t)-Authentication 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Authentication 

:'''Criteria for: All Users''' 
:Section 170.302(u)-Encryption 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Encryption

15. Report Clinical Quality Measures to CMS or the states. For 2011 provide aggregate numerator and denominator through attestation. For 2012, electronically submit measures. 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.302(i)-Report Quality Measures 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Report_Quality_Measures_%28EH/CAH%29 

:'''Criteria for: Eligible Professionals''' 
:Section 170.302(i)-Report Quality Measures 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Report_Quality_Measures_%28EP%29

===Meaningful Use - Menu Set (Pick 5 of 10) ===

1. Implement drug formulary checks. Drug formulary check system must be implemented and access at least one internal or external drug formulary during the reporting period. 

:'''Criteria for: All Users''' 
:Section 170.302(a)-Drug-Drug, Drug-Allergy, Drug-Formulary Checks 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Drug-Formulary_Checks

2. Incorporate clinical laboratory test results into EHRs as structured data. More than 40% of clinical laboratory test results are in positive/negative or numerical format and are incorporated into EHRs as structured data 

:'''Criteria for: All Users''' 
:Section 170.302(g)-Incorporate Laboratory Test Results 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Incorporate_Laboratory_Test_Results

3. Generate lists of patients by specific conditions for use for quality improvement, reduction of disparities, research or outreach. Must generate one listing of patients with a specific condition 

:'''Criteria for: All Users''' 
:Section 170.302(h)-Generate Patient Lists 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Generate_Patient_Lists

4. Use EHR technology to identify patient-specific education resources and provide those to the patient as appropriate. More than 10% of patients are provided patient specific education resources 

:'''Criteria for: All Users''' 
:Section N/A - Patient-specific Education Resources 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Patient-specific_Education_Resources

5. Perform Medication reconciliation between care settings. Medication reconciliation must be performed for more than 50% of transitions of care. 

:'''Criteria for: All Users''' 
:Section 170.302(l)-Medication Reconciliation 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Medication_Reconciliation

6. Provide summary of care record for patients referred or transitioned to another provider or setting. Summary of care record must be provided for more than 50% of patient transitions or referrals 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(i)-Exchange Clinical Information and Patient Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Provide_Summary_Of_Care_Record_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(f)-Exchange Clinical Information and Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Provide_Summary_Of_Care_Record_%28EH/CAH%29

7. Submission of electronic immunization data to immunization registries or immunization information systems. Must perform at least one test of data submission and follow-up submission (where registries can accept electronic submissions) 

:'''Criteria for: All Users''' 
:Section 170.302(m)-Submission to Immunization Registries 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Submission_to_Immunization_Registries

8. Submission of electronic syndromic surveillance data to public health agencies. Must perform at least one test of data submission and xe submission (where public health agencies can accept electronic data) 

:'''Criteria for: All Users''' 
:Section 170.302(n)-Public Health Surveillance 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Public_Health_Surveillance 
====For hospitals - 9 & 10====

9. Record advanced directives for patients 65 years or older. More than 50% of patients aged 65 or older must have an indication of an advanced directive status recorded. 

:'''Criteria for: Eligible Hospitals and CAHs''' 
Section N/A - Advance Directives 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Advance_Directives

10. Submission of electronic data on reportable laboratory results to public health agencies. Perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic data) 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(g)-Reportable Lab Results 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Reportable_Lab_Results_%28EH/CAH%29 
====For professionals - 9 & 10====

9. Send reminders to patients (per patient preference) for preventative and follow-up care. More than 20% of patients aged 65 or older or age 5 or younger must be sent appropriate reminders. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(d)-Generate Patient Reminder List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Generate_Patient_Reminder_List

10. Provide patients with timely electronic access to their health information (including laboratory results, problem list, medication list, medication allergies). More than 10% of patients must be provided with electronic access to information within 4 days of its being updated in the EHR. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(g)-Timely Access 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Timely_Access 
===Meaningful Use Data Exchanges===

====Core Set====
1. Provide patients an electronic copy of their ambulatory, ED or inpatient summary of care record record 
2. Transmit prescriptions 
3. Capability to exchange key clinical information among care providers and patient authorized entities 
4. Report clinical quality measures 
====Menu Set ====
5. Incorporate clinical lab tests results into EHRs as structured data 
6. Provide summary of care record for patients referred or transition to another provider or setting 
7. Capability to submit data to immunization registries, provide syndromic surveillance and lab data to public health agencies 
Another issue not in this PPT: 
The date, time, patient identification, and user identification must be recorded when electronic health information is created, modified, accessed, or deleted; and an indication of which action(s) occurred and by whom must also be recorded 

===Approved Test Procedures===
Each wiki pages described on this page contains a link to the NIST testing requirement specific to meaningful use criteria. 
Below is a link to the NIST page that lists all of the test procedure documents on one page: 
http://healthcare.nist.gov/use_testing/effective_requirements.html (updated to reflect V1.1 documents)

MU Stage1 Final Rule - Electronic Copy of Health Information (EH/CAH)

2010-12-11T18:29:33Z

Peterbodtke: Gap analysis section and content added

'''SECTION # '''
Section 170.306(d)—Electronic Copy of Health Information

'''MU OBJECTIVE'''
Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies, discharge summary, procedures), upon request.

'''MU STAGE 1 MEASURE'''
More than 50% of all patients of the EP or the inpatient or emergency departments of the eligible hospital or CAH (POS 21 or 23) who request an electronic copy of their health information are provided it within 3 business days.

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.306(d).
(1) Enable a user to create an electronic copy of a patient’s clinical information, including, at a minimum, diagnostic test results, problem list, medication list, medication allergy list, and procedures:
(i) In human readable format; and
(ii) On electronic media or through some other electronic means in accordance with:
(A) The standard (and applicable implementation specifications) specified in §170.205(a)(1) or §170.205(a)(2); and
(B) For the following data elements the applicable standard must be used:
(1) Problems. The standard specified in §170.207(a)(1) or, at a minimum, the version of the standard specified in §170.207(a)(2);
(2) Procedures. The standard specified in §170.207(b)(1) or §170.207(b)(2);
(3) Laboratory test results. At a minimum, the version of the standard specified in §170.207(c); and
(4) Medications. The standard specified in §170.207(d).
(2) Enable a user to create an electronic copy of a patient’s discharge summary in human readable format and on electronic media or through some other electronic means.

'''STANDARDS'''
§170.205(a)(1)
§170.205(a)(2)
§170.207(a)(1)
§170.207(a)(2)
§170.207(b)(1)
§170.207(b)(2)
§170.207(c)
§170.207(d)

'''TEST CRITERIA #'''
§170.306(d) 
http://healthcare.nist.gov/docs/170.306.d.1_ElectronicCopyOfHealthInformation_v1.1.pdf 
http://healthcare.nist.gov/docs/170.306.d.2_ElectronicCopyOfHealthInformation_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EH/CAH
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

===GAP ANALYSIS===
12/11/2010 1:28 PM (EDT)
{| class="grey" border="1" cellpadding="2"
|-
|
'''Test Procedure ID'''

|
'''VistA Functions'''

|
'''Captured'''

|
'''Comments'''

|
'''Questions'''

|
'''Testing Notes'''

|-
|
VE170.306.d.1 – 1.01

|
Create all five sample patients in advance using:

- patient demographics (PIMS = JoAnne Brougham)

- problem list (CPRS = CAC, Nedi Parks or Patti Henderson)

- prescriptions (inpatient or outpatient? = Marv Friedman)

- medication allergy (CPRS = Marv Friedman)

- - need a Snomed code for the allergy type

- - need to link RxNorm code to allergen

- lab (enter, accession, verify = Dan Gray)

- - need to link Lab tests to LOINC codes

- procedures (CPRS, TIU = CAC again)

|
 

|
Tester shall select one test data set from TD170.306.d.1 (Note contradiction with Required vendor information, which claims the vendor gets to pick the patient).

- We need to document how to do all of these things and train our lead tester and backup testers to be able to do all of this.

|
 

|
 

|-
|
VE170.306.d.1 – 1.01

|
Have Marv Friedman review drug requirements:

- are these inpatient pharmacy or outpatient

- if outpatient, can we use non-VA drugs to cover this

- if not, then we need to develop the CCR to handle inpatient Rx

|
 

|
 

|
 

|
 

|-
|
TE170.306.d.1 – 1.02

|
We need package experts to review how to do each of these things

We need to document how to do each of these things

We need to train the lead tester and backup testers in doing this

During the test, the lead tester needs to perform these actions

|
 

|
Vendor shall enter Vendor-supplied test data and/or NIST-supplied test data/examples into the patient record based on the data set selected by the Tester from TD170.306.d.1, including

- Diagnostic test results

- Problem list

- Medication list

- Medication allergy list

- Procedure list

|
 

|
 

|-
|
TE170.306.d.1 – 1.03

|
need to create UI to generate a CCR for a patient (EWD) (who?)

- we'll need an EWD team to develop this

- Rob Tweed, plus others to be determined

need a CPRS client mod to launch the VISTA Comm EWD app

- Steve Shreeve

These are almost the same requirements as for core 7 EP

- so solving it for one will solve it for both

- except core 7 EP has the tester running this code during test

|
 

|
Using the Vendor-supplied test data and/or NIST-supplied test data/examples and the EHR function(s) identified by the Vendor, the Tester shall create a copy of the patient’s clinical information on electronic media or other electronic means in the Vendor-selected HL7 CCD format or ASTM CCR format, including

- Diagnostic test results

- Problem list

- Medication list

- Medication allergy list

- Procedure list

|
 

|
 

|-
|
TE170.306.d.1 – 1.03

|
We need to confirm whether CCR handles all these data elements

Develop CCR further to handle any missing elements:

- Snomed code with allergy type

- RxNorm code with allergen

- LOINC code with lab test result

- possibly inpatient pharmacy data, which would be big development

|
 

|
 

|
 

|
 

|-
|
TE170.306.d.1 – 1.03

|
Given NIST's preference for CCDs and their choice of an unreliable CCR conformance testing tool, it may be essential for us to finish our CCD development so we can test with a CCD if need be.

What's left to be done?

- we need to resolve the reduced list of errors remaining

- it requires XSLT development talent

- Ken Miller, Nancy Anthracite, and Dave Mishler can help finish this off

- there are several other good people we could add

- if we're willing to pay we can finish this off in time

- a lot of hacking needs to be done to clean up the details

- we need to complete the development we already started

|
 

|
 

|
 

|
 

|-
|
TE170.306.d.1 – 1.04

|
Ensure that our CCR will pass a visual inspection

|
 

|
Using the NIST-supplied Inspection Test Guide, the Tester shall verify that the copy of the patient’s clinical information has been created correctly and without omission

Using the Vendor-supplied test data and/or the NIST-supplied test data/examples in the TD170.306.d.1. data set selected by the Tester, Tester shall verify that all of the patient clinical information data are stored in the patient’s record, including

- Diagnostic test results

- Problems

- Medications

- Medication allergies

- Procedures

|
 

|
 

|-
|
TE170.306.d.1 – 1.04

|
We need to test our CCR using the standard American Academy of Family Physicians and the CCR Acceleration Task Force CCR style sheet to confirm we can pass this.

|
 

|
Note that NIST's test suite is silent about this, but it follows from the requirement for CCDs.

|
 

|
 

|-
|
TE170.306.d.1 – 1.04

|
If we develop a CCD, we need to test it using the standard HL7 CCD style sheet to confirm we can pass this.

|
 

|
HL7 CCD style sheet – HL7 provides a style sheet to render HL7 CCD structured documents as part of the CCD specifications package. Contact HL7 directly for the specification package.

|
 

|
 

|-
|
TE170.306.d.1 – 1.04

|
We can estimate our CCR with a CCR validator

- <nowiki>http://chit.dyndns.org/CCRValidation</nowiki>

We then need to ensure that our CCR will pass the CCR conformance testing tool

- NIST has selected a broken Java-based CCR conformance testing tool

- this endangers the use of a CCR in testing

- potentially, we could try to make the SourceForge CCR Java validator work

- we would need someone who knows Java

- the CCR validator source code is available at SourceForge

- but it's not actually running successfully anywhere as a validation service

- we would need to set it up online as a validation service so people can test with it

|
 

|
Using the NIST-supplied conformance testing tool identified in the Conformance Test Tools section of this test procedure, Tester shall verify that the copy of the patient’s clinical information has been created in HL7 CCD format or ASTM CCR format, using the specified vocabularies, and in human readable form correctly and without omission, including

- Diagnostic test results

- Problems

- Medications

- Medication allergies

- Procedures

ASTM CCR – Open Health Data provides an ASTM CCR validation tool designed specifically to support this test procedure. The tool is available through the following:

- Files can be retrieved from the SourceForge site: <nowiki>http://sourceforge.net/projects/ccrvalidator</nowiki>

- Direct link to the file: <nowiki>http://sourceforge.net/projects/ccrvalidator/files/ValidationService/1.0/ValidationServi</nowiki> <nowiki>ce-1.0.wa</nowiki>r/download

- Source code location: <nowiki>http://ccrvalidator.svn.sourceforge.net/viewvc/ccrvalidator/branches/</nowiki>

|
 

|
 

|-
|
TE170.306.d.1 – 1.04

|
We can estimate our CCD with a CCD validator

- <nowiki>https://www.solventus.com/aquifer/ccrviewportcontainer.aspx</nowiki>

We then need to ensure that our CCD will pass the CCD conformance testing tool

- NIST has a CCD conformance testing tool

- it is available now at <nowiki>http://xreg2.nist.gov/cda-validation/index.html</nowiki>

- practice beforehand to prove our CCD will pass it

|
 

|
HL7 CCD/HITSP C32 – NIST provides an HL7 CCD/HITSP C32 validation tool designed specifically to support this test procedure. The tool is available in two forms:

- a downloadable package for local installation available at <nowiki>http://xreg2.nist.gov/cda-</nowiki> validation<nowiki>/mu.ht</nowiki>ml

- a web-accessable validator which is hosted by NIST available at <nowiki>http://xreg2.nist.gov/cda-validation/mu.html</nowiki>

Support for these tools is available by contacting:

- Andrew McCaffrey (<nowiki>andrew.mc</nowiki>caffrey@<nowiki>nist.gov</nowiki>)

- Computer Scientist

- National Institute of Standards and Technology (NIST)

- Information Technology Laboratory

|
 

|
 

|}

Meaningful Use Stage One Final Rule

2010-12-11T17:58:43Z

Peterbodtke: added gap analysis section

Core Set (15) and Menu Set (pick 5 of 10, include one population/public health measure) requirements

===Meaningful Use - Core Set (15)===

1. Record patient demographics (sex, race, ethnicity, date of birth, preferred language, and in the case of hospitals, date and preliminary cause of death in the event of mortality). More than 50% of patients' demographic data must be recorded as structured data 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(c)-Record Demographics 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Record_Demographics_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(b)-Record Demographics 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Record_Demographics_%28EH/CAH%29

2. Record vital signs and chart changes (height, weight, blood pressure, body mass index, growth charts for children). More than 50% of patients 2 years of age or older must have height, weight and blood pressure recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(e)-Record and Chart Vital Signs 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Record_and_Chart_Vital_Signs

3. Maintain up-to-date problem list of current and active diagnoses. More than 80% of patients must have at least one entry recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(b)-Maintain Up-To- Date Problem List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Maintain_Up-To-_Date_Problem_List

4. Maintain an active medication list. More than 80% of patients have at least one entry recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(c)-Maintain Active Medication List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Maintain_Active_Medication_List

5. Maintain an active medication allergy list. More than 80% of patients have at least one entry recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(d)-Maintain Active Medication Allergy List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Maintain_Active_Medication_Allergy_List

6. Record smoking status for patients 13 and older. More than 50% if patients age 13 or older have smoking status recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(f)-Smoking Status 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Smoking_Status

7. For professionals, provide patients with clinical summaries for each office visit; for hospitals provide an electronic copy of hospital discharge instructions upon request. Clinical summaries provided to patients for more than 50% of all visits within 3 business days. More than 50% of all patients who are discharged from an inpatient or ED of a hospital who request an electronic copy of their discharge instructions must be provided with it. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(h)-Clinical Summaries 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Clinical_Summaries 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(e)-Electronic Copy of Discharge Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronic_Copy_of_Discharge_Information_%28EH/CAH%29

8. Upon request, provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication list, medication allergies, and for hospitals discharge summary and procedures). More than 50% of requesting patients must receive an electronic copy within 3 business days. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(f)-Electronic Copy of Health Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronic_Copy_of_Health_Information_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(d)-Electronic Copy of Health Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronic_Copy_of_Health_Information_%28EH/CAH%29

9. Generate and transmit permissible prescriptions electronically (does not apply to hospitals). More than 40% must be transmitted electronically using certified EHR technology. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(b)-Electronically Exchange Prescription Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronically_Exchange_Prescription_Information

10. Computerized Provider Order Entry for Medication Orders. More than 30% of patients with at least one medication in their medication list must have at least one medication ordered through CPOE 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(a)-Computerized Provider Order Entry 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Computerized_Provider_Order_Entry_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(a)-Computerized Provider Order Entry 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Computerized_Provider_Order_Entry_%28EH/CAH%29

11. Implement drug-drug and drug-allergy interaction checks. Functionality must be enabled for these checks for the entire reporting period. 

:'''Criteria for: All Users''' 
:Section 170.302(a)-Drug-Drug, Drug-Allergy, Drug-Formulary Checks 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Drug-Drug_Drug-Allergy_Checks

12. Implement capability to electronically exchange key clinical information among providers and patient-authorized entities. Must perform at least one test of the EHR's capacity to electronically exchange information. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(i)-Exchange Clinical Information and Patient Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Capability_To_Exchange_Key_Clinical_Information_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(f)-Exchange Clinical Information and Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Capability_To_Exchange_Key_Clinical_Information_%28EH/CAH%29

13. Implement one clinical decision support rule and track compliance with that rule. One rule must be implemented. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(e)-Clinical Decision Support 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Clinical_Decision_Support_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(c)-Clinical Decision Support 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Clinical_Decision_Support_%28EH/CAH%29

14. Implement systems to protect privacy and security of patient data in the EHR. Must conduct or review a security risk analysis, implement security updates as necessary and correct identified security deficiencies. 

:'''Criteria for: All Users''' 
:Section 170.302(o)-Access Control 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Access_Control 

:'''Criteria for: All Users''' 
:Section 170.302(p)-Emergency Access 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Emergency_Access 

:'''Criteria for: All Users''' 
:Section 170.302(q)-Automatic Log-Off 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Automatic_Log-Off 

:'''Criteria for: All Users''' 
:Section 170.302(r)-Audit Log 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Audit_Log 

:'''Criteria for: All Users''' 
:Section 170.302(s)-Integrity 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Integrity 

:'''Criteria for: All Users''' 
:Section 170.302(t)-Authentication 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Authentication 

:'''Criteria for: All Users''' 
:Section 170.302(u)-Encryption 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Encryption

15. Report Clinical Quality Measures to CMS or the states. For 2011 provide aggregate numerator and denominator through attestation. For 2012, electronically submit measures. 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.302(i)-Report Quality Measures 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Report_Quality_Measures_%28EH/CAH%29 

:'''Criteria for: Eligible Professionals''' 
:Section 170.302(i)-Report Quality Measures 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Report_Quality_Measures_%28EP%29

===Meaningful Use - Menu Set (Pick 5 of 10) ===

1. Implement drug formulary checks. Drug formulary check system must be implemented and access at least one internal or external drug formulary during the reporting period. 

:'''Criteria for: All Users''' 
:Section 170.302(a)-Drug-Drug, Drug-Allergy, Drug-Formulary Checks 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Drug-Formulary_Checks

2. Incorporate clinical laboratory test results into EHRs as structured data. More than 40% of clinical laboratory test results are in positive/negative or numerical format and are incorporated into EHRs as structured data 

:'''Criteria for: All Users''' 
:Section 170.302(g)-Incorporate Laboratory Test Results 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Incorporate_Laboratory_Test_Results

3. Generate lists of patients by specific conditions for use for quality improvement, reduction of disparities, research or outreach. Must generate one listing of patients with a specific condition 

:'''Criteria for: All Users''' 
:Section 170.302(h)-Generate Patient Lists 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Generate_Patient_Lists

4. Use EHR technology to identify patient-specific education resources and provide those to the patient as appropriate. More than 10% of patients are provided patient specific education resources 

:'''Criteria for: All Users''' 
:Section N/A - Patient-specific Education Resources 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Patient-specific_Education_Resources

5. Perform Medication reconciliation between care settings. Medication reconciliation must be performed for more than 50% of transitions of care. 

:'''Criteria for: All Users''' 
:Section 170.302(l)-Medication Reconciliation 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Medication_Reconciliation

6. Provide summary of care record for patients referred or transitioned to another provider or setting. Summary of care record must be provided for more than 50% of patient transitions or referrals 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(i)-Exchange Clinical Information and Patient Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Provide_Summary_Of_Care_Record_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(f)-Exchange Clinical Information and Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Provide_Summary_Of_Care_Record_%28EH/CAH%29

7. Submission of electronic immunization data to immunization registries or immunization information systems. Must perform at least one test of data submission and follow-up submission (where registries can accept electronic submissions) 

:'''Criteria for: All Users''' 
:Section 170.302(m)-Submission to Immunization Registries 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Submission_to_Immunization_Registries

8. Submission of electronic syndromic surveillance data to public health agencies. Must perform at least one test of data submission and xe submission (where public health agencies can accept electronic data) 

:'''Criteria for: All Users''' 
:Section 170.302(n)-Public Health Surveillance 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Public_Health_Surveillance 
====For hospitals - 9 & 10====

9. Record advanced directives for patients 65 years or older. More than 50% of patients aged 65 or older must have an indication of an advanced directive status recorded. 

:'''Criteria for: Eligible Hospitals and CAHs''' 
Section N/A - Advance Directives 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Advance_Directives

10. Submission of electronic data on reportable laboratory results to public health agencies. Perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic data) 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(g)-Reportable Lab Results 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Reportable_Lab_Results_%28EH/CAH%29 
====For professionals - 9 & 10====

9. Send reminders to patients (per patient preference) for preventative and follow-up care. More than 20% of patients aged 65 or older or age 5 or younger must be sent appropriate reminders. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(d)-Generate Patient Reminder List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Generate_Patient_Reminder_List

10. Provide patients with timely electronic access to their health information (including laboratory results, problem list, medication list, medication allergies). More than 10% of patients must be provided with electronic access to information within 4 days of its being updated in the EHR. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(g)-Timely Access 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Timely_Access 
===Meaningful Use Data Exchanges===

====Core Set====
1. Provide patients an electronic copy of their ambulatory, ED or inpatient summary of care record record 
2. Transmit prescriptions 
3. Capability to exchange key clinical information among care providers and patient authorized entities 
4. Report clinical quality measures 
====Menu Set ====
5. Incorporate clinical lab tests results into EHRs as structured data 
6. Provide summary of care record for patients referred or transition to another provider or setting 
7. Capability to submit data to immunization registries, provide syndromic surveillance and lab data to public health agencies 
Another issue not in this PPT: 
The date, time, patient identification, and user identification must be recorded when electronic health information is created, modified, accessed, or deleted; and an indication of which action(s) occurred and by whom must also be recorded 

===Approved Test Procedures===
Each wiki pages described on this page contains a link to the NIST testing requirement specific to meaningful use criteria. 
Below is a link to the NIST page that lists all of the test procedure documents on one page: 
http://healthcare.nist.gov/use_testing/effective_requirements.html (updated to reflect V1.1 documents)

===Certification Gap Analysis===
View the gap analysis (a work in process) https://spreadsheets.google.com/pub?key=0AlQZej7rI2MddFFsa0VvQUx5eVVXUXVjV0dUTjQyUkE&hl=en&output=html

Meaningful Use Stage One Final Rule

2010-11-29T23:43:12Z

Peterbodtke: updated to point to latest NIST test procedures

Core Set (15) and Menu Set (pick 5 of 10, include one population/public health measure) requirements

===Meaningful Use - Core Set (15)===

1. Record patient demographics (sex, race, ethnicity, date of birth, preferred language, and in the case of hospitals, date and preliminary cause of death in the event of mortality). More than 50% of patients' demographic data must be recorded as structured data 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(c)-Record Demographics 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Record_Demographics_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(b)-Record Demographics 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Record_Demographics_%28EH/CAH%29

2. Record vital signs and chart changes (height, weight, blood pressure, body mass index, growth charts for children). More than 50% of patients 2 years of age or older must have height, weight and blood pressure recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(e)-Record and Chart Vital Signs 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Record_and_Chart_Vital_Signs

3. Maintain up-to-date problem list of current and active diagnoses. More than 80% of patients must have at least one entry recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(b)-Maintain Up-To- Date Problem List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Maintain_Up-To-_Date_Problem_List

4. Maintain an active medication list. More than 80% of patients have at least one entry recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(c)-Maintain Active Medication List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Maintain_Active_Medication_List

5. Maintain an active medication allergy list. More than 80% of patients have at least one entry recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(d)-Maintain Active Medication Allergy List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Maintain_Active_Medication_Allergy_List

6. Record smoking status for patients 13 and older. More than 50% if patients age 13 or older have smoking status recorded as structured data. 

:'''Criteria for: All Users''' 
:Section 170.302(f)-Smoking Status 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Smoking_Status

7. For professionals, provide patients with clinical summaries for each office visit; for hospitals provide an electronic copy of hospital discharge instructions upon request. Clinical summaries provided to patients for more than 50% of all visits within 3 business days. More than 50% of all patients who are discharged from an inpatient or ED of a hospital who request an electronic copy of their discharge instructions must be provided with it. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(h)-Clinical Summaries 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Clinical_Summaries 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(e)-Electronic Copy of Discharge Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronic_Copy_of_Discharge_Information_%28EH/CAH%29

8. Upon request, provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication list, medication allergies, and for hospitals discharge summary and procedures). More than 50% of requesting patients must receive an electronic copy within 3 business days. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(f)-Electronic Copy of Health Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronic_Copy_of_Health_Information_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(d)-Electronic Copy of Health Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronic_Copy_of_Health_Information_%28EH/CAH%29

9. Generate and transmit permissible prescriptions electronically (does not apply to hospitals). More than 40% must be transmitted electronically using certified EHR technology. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(b)-Electronically Exchange Prescription Information 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Electronically_Exchange_Prescription_Information

10. Computerized Provider Order Entry for Medication Orders. More than 30% of patients with at least one medication in their medication list must have at least one medication ordered through CPOE 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(a)-Computerized Provider Order Entry 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Computerized_Provider_Order_Entry_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(a)-Computerized Provider Order Entry 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Computerized_Provider_Order_Entry_%28EH/CAH%29

11. Implement drug-drug and drug-allergy interaction checks. Functionality must be enabled for these checks for the entire reporting period. 

:'''Criteria for: All Users''' 
:Section 170.302(a)-Drug-Drug, Drug-Allergy, Drug-Formulary Checks 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Drug-Drug_Drug-Allergy_Checks

12. Implement capability to electronically exchange key clinical information among providers and patient-authorized entities. Must perform at least one test of the EHR's capacity to electronically exchange information. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(i)-Exchange Clinical Information and Patient Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Capability_To_Exchange_Key_Clinical_Information_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(f)-Exchange Clinical Information and Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Capability_To_Exchange_Key_Clinical_Information_%28EH/CAH%29

13. Implement one clinical decision support rule and track compliance with that rule. One rule must be implemented. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(e)-Clinical Decision Support 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Clinical_Decision_Support_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(c)-Clinical Decision Support 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Clinical_Decision_Support_%28EH/CAH%29

14. Implement systems to protect privacy and security of patient data in the EHR. Must conduct or review a security risk analysis, implement security updates as necessary and correct identified security deficiencies. 

:'''Criteria for: All Users''' 
:Section 170.302(o)-Access Control 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Access_Control 

:'''Criteria for: All Users''' 
:Section 170.302(p)-Emergency Access 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Emergency_Access 

:'''Criteria for: All Users''' 
:Section 170.302(q)-Automatic Log-Off 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Automatic_Log-Off 

:'''Criteria for: All Users''' 
:Section 170.302(r)-Audit Log 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Audit_Log 

:'''Criteria for: All Users''' 
:Section 170.302(s)-Integrity 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Integrity 

:'''Criteria for: All Users''' 
:Section 170.302(t)-Authentication 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Authentication 

:'''Criteria for: All Users''' 
:Section 170.302(u)-Encryption 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Encryption

15. Report Clinical Quality Measures to CMS or the states. For 2011 provide aggregate numerator and denominator through attestation. For 2012, electronically submit measures. 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.302(i)-Report Quality Measures 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Report_Quality_Measures_%28EH/CAH%29 

:'''Criteria for: Eligible Professionals''' 
:Section 170.302(i)-Report Quality Measures 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Report_Quality_Measures_%28EP%29

===Meaningful Use - Menu Set (Pick 5 of 10) ===

1. Implement drug formulary checks. Drug formulary check system must be implemented and access at least one internal or external drug formulary during the reporting period. 

:'''Criteria for: All Users''' 
:Section 170.302(a)-Drug-Drug, Drug-Allergy, Drug-Formulary Checks 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Drug-Formulary_Checks

2. Incorporate clinical laboratory test results into EHRs as structured data. More than 40% of clinical laboratory test results are in positive/negative or numerical format and are incorporated into EHRs as structured data 

:'''Criteria for: All Users''' 
:Section 170.302(g)-Incorporate Laboratory Test Results 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Incorporate_Laboratory_Test_Results

3. Generate lists of patients by specific conditions for use for quality improvement, reduction of disparities, research or outreach. Must generate one listing of patients with a specific condition 

:'''Criteria for: All Users''' 
:Section 170.302(h)-Generate Patient Lists 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Generate_Patient_Lists

4. Use EHR technology to identify patient-specific education resources and provide those to the patient as appropriate. More than 10% of patients are provided patient specific education resources 

:'''Criteria for: All Users''' 
:Section N/A - Patient-specific Education Resources 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Patient-specific_Education_Resources

5. Perform Medication reconciliation between care settings. Medication reconciliation must be performed for more than 50% of transitions of care. 

:'''Criteria for: All Users''' 
:Section 170.302(l)-Medication Reconciliation 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Medication_Reconciliation

6. Provide summary of care record for patients referred or transitioned to another provider or setting. Summary of care record must be provided for more than 50% of patient transitions or referrals 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(i)-Exchange Clinical Information and Patient Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Provide_Summary_Of_Care_Record_%28EP%29 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(f)-Exchange Clinical Information and Summary Record 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Provide_Summary_Of_Care_Record_%28EH/CAH%29

7. Submission of electronic immunization data to immunization registries or immunization information systems. Must perform at least one test of data submission and follow-up submission (where registries can accept electronic submissions) 

:'''Criteria for: All Users''' 
:Section 170.302(m)-Submission to Immunization Registries 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Submission_to_Immunization_Registries

8. Submission of electronic syndromic surveillance data to public health agencies. Must perform at least one test of data submission and xe submission (where public health agencies can accept electronic data) 

:'''Criteria for: All Users''' 
:Section 170.302(n)-Public Health Surveillance 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Public_Health_Surveillance 
====For hospitals - 9 & 10====

9. Record advanced directives for patients 65 years or older. More than 50% of patients aged 65 or older must have an indication of an advanced directive status recorded. 

:'''Criteria for: Eligible Hospitals and CAHs''' 
Section N/A - Advance Directives 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Advance_Directives

10. Submission of electronic data on reportable laboratory results to public health agencies. Perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic data) 

:'''Criteria for: Eligible Hospitals and CAHs''' 
:Section 170.306(g)-Reportable Lab Results 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Reportable_Lab_Results_%28EH/CAH%29 
====For professionals - 9 & 10====

9. Send reminders to patients (per patient preference) for preventative and follow-up care. More than 20% of patients aged 65 or older or age 5 or younger must be sent appropriate reminders. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(d)-Generate Patient Reminder List 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Generate_Patient_Reminder_List

10. Provide patients with timely electronic access to their health information (including laboratory results, problem list, medication list, medication allergies). More than 10% of patients must be provided with electronic access to information within 4 days of its being updated in the EHR. 

:'''Criteria for: Eligible Professionals''' 
:Section 170.304(g)-Timely Access 
:http://vistapedia.net/index.php?title=MU_Stage1_Final_Rule_-_Timely_Access 
===Meaningful Use Data Exchanges===

====Core Set====
1. Provide patients an electronic copy of their ambulatory, ED or inpatient summary of care record record 
2. Transmit prescriptions 
3. Capability to exchange key clinical information among care providers and patient authorized entities 
4. Report clinical quality measures 
====Menu Set ====
5. Incorporate clinical lab tests results into EHRs as structured data 
6. Provide summary of care record for patients referred or transition to another provider or setting 
7. Capability to submit data to immunization registries, provide syndromic surveillance and lab data to public health agencies 
Another issue not in this PPT: 
The date, time, patient identification, and user identification must be recorded when electronic health information is created, modified, accessed, or deleted; and an indication of which action(s) occurred and by whom must also be recorded 

===Approved Test Procedures===
Each wiki pages described on this page contains a link to the NIST testing requirement specific to meaningful use criteria. 
Below is a link to the NIST page that lists all of the test procedure documents on one page: 
http://healthcare.nist.gov/use_testing/effective_requirements.html (updated to reflect V1.1 documents)

MU Stage1 Final Rule - Timely Access

2010-11-29T23:41:31Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.304(g)—Timely Access

'''MU 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.

'''MU STAGE 1 MEASURE'''
More than 10% 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.

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.304(g).
Timely access. Enable a user to provide patients with online access to their clinical information, including, at a minimum, lab test results, problem list, medication list, and medication allergy list.

'''STANDARDS'''
N/A

'''TEST CRITERIA #'''
§170.304(g)
http://healthcare.nist.gov/docs/170.304.g_TimelyAccess_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EP
| MENU
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''

There was initial thoughts about using PHR's -- Google Health, or Microsoft health vault etc. But upon further consideration, these agencies specifically say that they are NOT a HIPPA-covered entity. Thus they are not really a reasonable channel for sending results out to patients.

John Williams, on a telephone call, commented that he is considering offering a secure HIPPA-covered PHR as a service (for fee). If he, or anyone else did this, there certainly would be security factors that would have to be carefully monitored -- to prevent hackers from accessing it etc, so service support would be reasonable.

A simple application that allows a patient to log in securely and retrieve and/or view their latest CCR or CCD produced using the software from the CCR-CCD project should satisfy this requirement nicely and there is a good chance some of this work will be done at the coding meeting Feb. 26-March 1 at RMU. The provider should probably be the one to upload the document that the patient will view to allow selective editing of what will be presented other than the complete CCR or CCD. This is what the CCR-CCD has been calling a "pick list" GUI which is part of the plans for what is to be developed as part of the project.

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Generate Patient Reminder List

2010-11-29T23:41:07Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.304(d)—Generate Patient Reminder List

'''MU OBJECTIVE'''
Send reminders to patients per patient preference for preventive/ follow up care

'''MU STAGE 1 MEASURE'''
More than 20% of all unique patients 65 years or older or 5years old or younger were sent an appropriate reminder during the EHR reporting period

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.304(d).
Patient reminders. Enable a user to electronically generate a patient reminder list for preventive or follow-up care according to patient preferences based on, at a minimum, the data elements included in:
(1) Problem list;
(2) Medication list;
(3) Medication allergy list;
(4) Demographics; and
(5) Laboratory test results.

'''STANDARDS'''
N/A

'''TEST CRITERIA #'''
§170.304(d)
http://healthcare.nist.gov/docs/170.304.d_GeneratePatientReminders_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EP
| MENU
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Reportable Lab Results (EH/CAH)

2010-11-29T23:40:28Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.306(g)—Reportable Lab Results

'''MU OBJECTIVE'''
Capability to submit electronic data on reportable (as required by state or local law) lab results to public health agencies and actual submission in accordance with applicable law and practice

'''MU STAGE 1 MEASURE'''
Performed at least one test of certified EHR technology’s capacity to provide electronic submission of reportable lab results to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.306(g).
Reportable lab results. Electronically record, modify, retrieve, and submit reportable clinical lab results in accordance with the standard (and applicable implementation specifications) specified in §170.205(c) and, at a minimum, the version of the standard specified in §170.207(c).

'''STANDARDS'''
§170.205(c)
§170.207(c)

'''TEST CRITERIA #'''
§170.306(g)
http://healthcare.nist.gov/docs/170.306.g_LabstoPH_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EH/CAH
| MENU
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Advance Directives

2010-11-29T23:40:04Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
N/A

'''MU OBJECTIVE'''
Record advance directives for patients 65 years old or older

'''MU STAGE 1 MEASURE'''
More than 50% of all unique patients 65 years old or older admitted to the eligible hospital’s or CAH’s inpatient department (POS 21) have an indication of an advance directive status recorded

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.306(h).
Advance directives. Enable a user to electronically record whether a patient has an advance directive.

'''STANDARDS'''
N/A

'''TEST CRITERIA #'''
§170.306(h)
http://healthcare.nist.gov/docs/170.306.h_AdvDirectives_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EH/CAH
| MENU
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Public Health Surveillance

2010-11-29T23:39:24Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(n)—Public Health Surveillance

'''MU OBJECTIVE'''
Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice.

'''MU STAGE 1 MEASURE'''
Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP, el

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.302(l).
Public health surveillance. Electronically record, modify, retrieve, and submit syndrome-based public health surveillance information in accordance with the standard (and applicable implementation specifications) specified in §170.205(d)(1) or §170.205(d)(2).

'''STANDARDS'''
§170.205(d)(1)
§170.205(d)(2)

'''TEST CRITERIA #'''
§170.302(l)
http://healthcare.nist.gov/docs/170.302.l_PublicHealthSurveillance_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| MENU
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Submission to Immunization Registries

2010-11-29T23:38:49Z

Peterbodtke: updated NIST test script version number

MU Stage1 Final Rule - Provide Summary Of Care Record (EH/CAH)

2010-11-29T23:38:10Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.306(f)—Exchange Clinical
Information and Summary Record

'''MU OBJECTIVE'''
The EP, eligible hospital or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral.

'''MU STAGE 1 MEASURE'''
The EP, eligible hospital or CAH 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.

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.306(f).
(1) Electronically receive and display. Electronically receive and display a patient’s summary record from other providers and organizations including, at a minimum, diagnostic test results, problem list, medication list, medication allergy list, and procedures in accordance with the standard (and applicable implementation specifications) specified in §170.205(a)(1) or §170.205(a)(2). Upon receipt of a patient summary record formatted according to the alternative standard, display it in human readable format.
(2) Electronically transmit. Enable a user to electronically transmit a patient’s summary record to other providers and organizations including, at a minimum, diagnostic results, problem list, medication list, medication allergy list, and procedures in accordance with:
(i) The standard (and applicable implementation specifications) specified in §170.205(a)(1) or §170.205(a)(2); and
(ii) For the following data elements the applicable standard must be used:
(A) Problems. The standard specified in §170.207(a)(1) or, at a minimum, the version of the standard specified in §170.207(a)(2);
(B) Procedures. The standard specified in §170.207(b)(1) or §170.207(b)(2);
(C) Laboratory test results. At a minimum, the version of the standard specified in §170.207(c); and
(D) Medications. The standard specified in §170.207(d).

'''STANDARDS'''
§170.205(a)(1)
§170.205(a)(2)
§170.207(a)(1)
§170.207(a)(2)
§170.207(b)(1)
§170.207(b)(2)
§170.207(c)
§170.207(d)

'''TEST CRITERIA #'''
§170.306(f)
http://healthcare.nist.gov/docs/170.306.f_ExchangeClinicalinfoSummaryRecordIP_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EH/CAH
| CORE
| WorldVistA, et al
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Provide Summary Of Care Record (EP)

2010-11-29T23:37:33Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.304(i)—Exchange Clinical Information and Patient Summary Record

'''MU OBJECTIVE'''
The EP, eligible hospital or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral.

'''MU STAGE 1 MEASURE'''
The EP, eligible hospital or CAH 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.

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.304(i)
(1) Electronically receive and display. Electronically receive and display a patient’s summary record, from other providers and organizations including, at a minimum, diagnostic tests results, problem list, medication list, and medication allergy list in accordance with the standard (and applicable implementation specifications) specified in §170.205(a)(1) or §170.205(a)(2).
Upon receipt of a patient summary record formatted according to the alternative standard, display it in human readable format.
(2) Electronically transmit. Enable a user to electronically transmit a patient summary record to other providers and organizations including, at a minimum, diagnostic test results, problem list, medication list, and medication allergy list in accordance with:
(i) The standard (and applicable implementation specifications) specified in §170.205(a)(1) or §170.205(a)(2); and
(ii) For the following data elements the applicable standard must be used:
(A) Problems. The standard specified in §170.207(a)(1) or, at a minimum, the version of the standard specified in §170.207(a)(2);
(B) Laboratory test results. At a minimum, the version of the standard specified in §170.207(c); and
(C) Medications. The standard specified in §170.207(d).

'''STANDARDS'''
§170.205(a)(1)
§170.205(a)(2)
§170.205(a)(2)
§170.207(a)(1)
§170.207(a)(2)
§170.207(c)
§170.207(d)

'''TEST CRITERIA #'''
§170.304(i)
http://healthcare.nist.gov/docs/170.304.i_ExchangeClinicalinforPatientSummaryRecordAmb_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EP
| MENU
| WorldVistA, et al
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''

(1) This capability will be provided by the code coming from the CCR-CCD project. The latest project code can be found on http://trac.opensourcevista.net and there are calls almost every Tuesday night at 9 PM Eastern to work on the project. You can sign up to receive notices of the meetings at http://groups.google.com/group/ccd-ccr-project?hl=en . Both a CCR and CCD level 2 are being produced at this time and we are hoping that there will be the capability of transmitting a CCD level 3 in the future as that work is underway. WorldVistA will be submitting a recommendation to the ONCHIT to use both the CCR and CCD as standards for transmission of these health summaries. The production of an XSLT transform to create a CCD level 3 from a CCR, which is the current goal of some work being done by Ken Miller of Solventus as an open source project funded by Oroville Hopital in California, should make this easily possible for healthcare providers.

(2)This will also be covered by the CCR-CCD project. Either a CCR or CCD level 2 is something that can be extracted at this time. (see above) This particular standard does not specify how the transmission must be done. It is clear that it must be encrypted but it is not clear how it may be transmitted. Then NHIN is mentioned but there it is not clear that other methods of transport are not allowed such as email with an encrypted attachment. (There is mention that if it is physically transported outside of a healthcare facility, it should be encrypted.)
'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Medication Reconciliation

2010-11-29T23:37:01Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(l)—Medication Reconciliation

'''MU OBJECTIVE'''
The EP, eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation

'''MU STAGE 1 MEASURE'''
The EP, eligible hospital or CAH performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23).

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.302(j)
Medication reconciliation. Enable a user to electronically compare two or more medication lists.

'''STANDARDS'''
N/A

'''TEST CRITERIA #'''
§170.302 (j)
http://healthcare.nist.gov/docs/170.302.j_%20MedicationReconciliation_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| MENU
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Generate Patient Lists

2010-11-29T23:36:27Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(h)—Generate Patient Lists

'''MU OBJECTIVE'''
Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach.

'''MU STAGE 1 MEASURE'''
Generate at least one report listing patients of the EP, eligible hospital or CAH with a specific condition.

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.302(i).
Generate patient lists. Enable a user to electronically select, sort, retrieve, and generate lists of patients according to, at a minimum, the data elements included in:
(1) Problem list;
(2) Medication list;
(3) Demographics; and
(4) Laboratory test results.

'''STANDARDS'''
N/A

'''TEST CRITERIA #'''
§170.302(i)
http://healthcare.nist.gov/docs/170.302.i_GeneratePatientLists_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| MENU
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Incorporate Laboratory Test Results

2010-11-29T23:35:56Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(g)—Incorporate Laboratory Test Results

'''MU OBJECTIVE'''
Incorporate clinical lab-test results into certified EHR technology as structured data.

'''MU STAGE 1 MEASURE'''
More than 40% of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23) during the EHR reporting period whose results are

'''CERTIFICATION CRITERION'''
Interim Final Rule Text:
(1) Receive results. Electronically receive clinical laboratory test results in a structured format and display such results in human readable format.
(2) Display codes in readable format. Electronically display in human readable format any clinical laboratory tests that have been received with LOINC® codes.
(3) Display test report information. Electronically display all the information for a test report specified at 42 CFR 493.1291(c)(1) through (7).
(4) Update. Enable a user to electronically update a patient’s record based upon received laboratory test results.
Final Rule Text: §170.302(h).
(1) Unchanged.
(2) Display test report information. Electronically display all the information for a test report specified at 42 CFR 493.1291(c)(1) through (7).
(3) Incorporate results. Electronically attribute, associate, or link a laboratory test result to a laboratory order or patient record.

'''STANDARDS'''
42 CFR 493.1291(c)(1) through (7)
http//:edocket.access.gpo.gov/cfr_2006/octqtr/pdf/42cfr493.1291.pdf

'''TEST CRITERIA #'''
§170.302(h)
http://healthcare.nist.gov/docs/170.302.h_IncorpLabTest_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| MENU
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''

VistA does store data in a structured format and can receive data but only if it was ordered properly in the first place and the order sent to the lab. The problem of receiving data that was not previously ordered and documented in the standard way used for sending samples to a referral laboratory needs to be tackled and will be as part of the VistA Lab Project (now on hiatus) that meets on Monday nights.

Also, the data received will need to be associated with tests within VistA in order to be pulled and graphed properly. This also has to deal with receiving data from multiple labs.

This is not an easy problem to solve and was going to be part of the project being done in Hawaii with RPMS, but do to the untimely death of Art Koga whose company was going to do the work and provide it back to the community with the permission of the U of Hawaii, there may not be any contribution from Hawaii now.

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Drug-Formulary Checks

2010-11-29T23:34:41Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(a)—Drug-Drug, Drug-Allergy, Drug-Formulary Checks

'''MU OBJECTIVE'''
Implement drug-formulary checks

'''MU STAGE 1 MEASURE'''
The EP/eligible hospital/CAH has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR reporting period.

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.302(b).
Drug-formulary checks. Enable a user to electronically check if drugs are in a formulary or preferred drug list.

'''STANDARDS'''
N/A

'''TEST CRITERIA #'''
§170.302(b)
http://healthcare.nist.gov/docs/170.302.b_DrugFormularyChecks_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| MENU
| Oroville
| In development
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''

Note: VistA currently doesn't maintain formularies. This will need to be done with an interface to a 3rd party application, such as the NewCrop ePrescibing service. Drug interactions are handled in VistA but because of the additional requirements, the current approach is that ePrescribing is used to check for allergies and interactions as part of that service using the drug database of the ePrescribing service. The first service being interfaced with it the NewCrop service which uses the First Databank Database that is the same one the VA was slated to use. The VA was slated to release the source code for that project but the project was stopped as it was running over budget and is under review, so we can't expect any help from the VA code anytime soon. The work being done and funded by Oroville hospital as an extension of the CCR-CCD project to provide ePrescribing is vital to this effort. It will be released as open source when it is completed.

Eventually the code for ePrescibing can potentially come ""in house"" so that VistA instances can become their own ePrescribing service with interfaces to the insurance eligibility and formulary databases (proprietary), Sure Scripts and the commercial drug databases, but Phase one of this effort is to use the ePrescibing service software provided by the ePrescribing service and to send demographics, allergies and medication lists to the service and to return lists augmented by additional information brought back from the service, i.e., additional allergies and medications provided by other providers, etc.
The third item may be difficult to provide in the setting of using the ePrescribing service.

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Report Quality Measures (EP)

2010-11-29T23:34:04Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(i)—Report Quality Measures

'''MU OBJECTIVE'''
Eligible Professionals: Report ambulatory clinical quality measures to CMS or the States.

'''MU STAGE 1 MEASURE'''
For 2011, provide aggregate numerator, denominator, and exclusions through For 2011, provide aggregate numerator, denominator, and exclusions through attestation as discussed in section II(A)(3) of [the Medicare and Medicaid EHR Incentive Programs final rule].
For 2012, electronically submit the clinical quality measures as discussed in section II(A)(3) of [the Medicare and Medicaid EHR Incentive Programs final rule].

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.304(j).
(1) Calculate.
(i) Electronically calculate all of the core clinical measures specified by CMS for eligible professionals.
(ii) Electronically calculate, at a minimum, three clinical quality measures specified by CMS for eligible professionals, in addition to those clinical quality measures specified in paragraph (1)(i).
(2) Submission. Enable a user to electronically submit calculated clinical quality measures in accordance with the standard and implementation specifications specified in §170.205(f).

'''STANDARDS'''
§170.205(f)

'''TEST CRITERIA #'''
§170.304 (j)
http://healthcare.nist.gov/docs/170.304.j_CalcSubmitClinQualityMeasures_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EP
| CORE
| WorldVistA, et al
| In development
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''

Table 2A row 5 specifies that the criteria for PQRI be used. For submitting this for the ambulatory setting, and EHR may use the standard billing submission with addtional codes that are not yet part of VistA. In addition, there are 175 baseline quality measures from CMS that may be chosen for this reporting. Also of these would probably best be handled by some rich reminders, but creating reminders is a tricky process.
As discussed elsewhere, configuration of billing needs to be done in VistA and/or a billing system interfaced with or incorporated that has all of the necessary capabilities.

Matt King has agreed to work with the community collectively to create these reminders to feed into the output that needs to be submitted, but he feels that he has more to learn about doing creating reminders so there is a combination needed of those who want to learn a to then help create them and those who are experts and are willing to point out the problems in the creation of them.
Unfortunately, the very fine VeHU training site that had a lot of reminder training that was very good has been partially deprecated deleting some of the best of the training. Nancy Anthracite has been informed that she ultimately will have her FOIA request for the site fulfilled, but so far that has not happened.

It may be that only one quality measure needs to be submitted to satisfy the CMS requirements for proof of Meaningful Use initially, but ultimately, groups need to submit 20+ measures, and which those measures are changes yearly and ambulatory clinics will need to submit about 6-8 in order to qualify.
Laura Morales feels that some additional changes in demographics will be required for reporting.

Initial reporting of this will require use of 4010 X12 transactions with was avialable free of charge until 2006 so copies of that are available. 12/31/2011 the 5010 version will be required and these are very expensive. Nancy Anthracite has requested that the X12 membership for non-profit organizations be modified to include smaller nonprofits to lower the cost for access to the code and the staff of the standards body has submitted that request to the their leadership for consideration. There are discounts offered to members but the code sets still cost in the thousands of dollars and I suspect VistA from the VA, once it is configured, is using the 4010 sets. Nancy will try to find out when/if the VA will transition to the 5010 set.
'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Report Quality Measures (EH/CAH)

2010-11-29T23:33:27Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(i)—Report Quality Measures

'''MU OBJECTIVE'''
Eligible Hospitals and CAHs: Report hospital clinical quality measures to CMS or the States.

'''MU STAGE 1 MEASURE'''
For 2012, electronically submit the clinical quality measures as discussed in section II(A)(3) of [the Medicare and Medicaid EHR Incentive Programs final rule].

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.306(i).
(1) Calculate. Electronically calculate all of the clinical quality measures specified by CMS for eligible hospitals and critical access hospitals.
(2) Submission. Enable a user to electronically submit calculated clinical quality measures in accordance with the standard and implementation specifications specified in §170.205(f).

'''STANDARDS'''
§170.205(f)[http://vistapedia.net/index.php?title=EP_Measure_Specifications_Overview EP Measure Overview]

'''TEST CRITERIA #'''
§170.306(i)
http://healthcare.nist.gov/docs/170.306.i_CalcSubmitClinQualityMeasures_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EH/CAH
| CORE
| WorldVistA, et al
| In development
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''

Table 2A row 5 specifies that the criteria for PQRI be used. For submitting this for the ambulatory setting, and EHR may use the standard billing submission with addtional codes that are not yet part of VistA. In addition, there are 175 baseline quality measures from CMS that may be chosen for this reporting. Also of these would probably best be handled by some rich reminders, but creating reminders is a tricky process.
As discussed elsewhere, configuration of billing needs to be done in VistA and/or a billing system interfaced with or incorporated that has all of the necessary capabilities.

Matt King has agreed to work with the community collectively to create these reminders to feed into the output that needs to be submitted, but he feels that he has more to learn about doing creating reminders so there is a combination needed of those who want to learn a to then help create them and those who are experts and are willing to point out the problems in the creation of them.
Unfortunately, the very fine VeHU training site that had a lot of reminder training that was very good has been partially deprecated deleting some of the best of the training. Nancy Anthracite has been informed that she ultimately will have her FOIA request for the site fulfilled, but so far that has not happened.

It may be that only one quality measure needs to be submitted to satisfy the CMS requirements for proof of Meaningful Use initially, but ultimately, groups need to submit 20+ measures, and which those measures are changes yearly and ambulatory clinics will need to submit about 6-8 in order to qualify.
Laura Morales feels that some additional changes in demographics will be required for reporting.

Initial reporting of this will require use of 4010 X12 transactions with was avialable free of charge until 2006 so copies of that are available. 12/31/2011 the 5010 version will be required and these are very expensive. Nancy Anthracite has requested that the X12 membership for non-profit organizations be modified to include smaller nonprofits to lower the cost for access to the code and the staff of the standards body has submitted that request to the their leadership for consideration. There are discounts offered to members but the code sets still cost in the thousands of dollars and I suspect VistA from the VA, once it is configured, is using the 4010 sets. Nancy will try to find out when/if the VA will transition to the 5010 set.

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Encryption

2010-11-29T23:32:40Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(u)—Encryption

'''MU OBJECTIVE'''
Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

'''MU STAGE 1 MEASURE'''
Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.302(u).
General encryption. Encrypt and decrypt electronic health information in accordance with the standard specified in §170.210(a)(1), unless the Secretary determines that the use of such algorithm would pose a significant security risk for Certified EHR Technology.
§170.302(v).
Encryption when exchanging electronic health information.
Encrypt and decrypt electronic health information when exchanged in accordance with the standard specified in §170.210(a)(2).

'''STANDARDS'''
§170.210(a)(1)
§170.210(a)(2)
45 CFR 164.308
http//:edocket.access.gpo.gov/cfr_2003/octqtr/pdf/45cfr164.308.pdf

'''TEST CRITERIA #''' 
§170.302(u)
http://healthcare.nist.gov/docs/170.302.u_GeneralEncryption_v1.1.pdf 
§170.302(v)
http://healthcare.nist.gov/docs/170.302.v_EncryptionHIE_v1.1.pdf

{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Authentication

2010-11-29T23:32:09Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(t)—Authentication

'''MU OBJECTIVE'''
Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

'''MU STAGE 1 MEASURE'''
Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.302(t).
Authentication. Verify that a person or entity seeking access to electronic health information is the one claimed and is authorized to access such information.

'''STANDARDS'''
45 CFR 164.308
http://edocket.access.gpo.gov/cfr_2003/octqtr/pdf/45cfr164.308.pdf

'''TEST CRITERIA #'''
§170.302(t)
http://healthcare.nist.gov/docs/170.302.t_Authentication_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Integrity

2010-11-29T23:31:39Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(s)—Integrity

'''MU OBJECTIVE'''
Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

'''MU STAGE 1 MEASURE'''
Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.302(s).
(1) Create a message digest in accordance with the standard specified in 170.210(c).
(2) Verify in accordance with the standard specified in 170.210(c) upon receipt of electronically exchanged health information that such information has not been altered.
(3) Detection. Detect the alteration of audit logs.
'''STANDARDS'''
170.210(c)
45 CFR 164.308
http//:edocket.access.gpo.gov/cfr_2003/octqtr/pdf/45cfr164.308.pdf

'''TEST CRITERIA #'''
§170.302(s)
http://healthcare.nist.gov/docs/170.302.s_Integrity_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Audit Log

2010-11-29T23:31:11Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(r)—Audit Log

'''MU OBJECTIVE'''
Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

'''MU STAGE 1 MEASURE'''
Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.302(r).
(1) Record actions. Record actions related to electronic health information in accordance with the standard specified in §170.210(b).
(2) Generate audit log. Enable a user to generate an audit log for a specific time period and to sort entries in the audit log according to any of the elements specified in the standard at 170.210(b).

'''STANDARDS'''
170.210(b)
45 CFR 164.308
http://edocket.access.gpo.gov/cfr_2003/octqtr/pdf/45cfr164.308.pdf

'''TEST CRITERIA #'''
§170.302(r)
http://healthcare.nist.gov/docs/170.302.r_AuditLog_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Automatic Log-Off

2010-11-29T23:30:37Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(q)—Automatic Log-Off

'''MU OBJECTIVE'''
Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

'''MU STAGE 1 MEASURE'''
Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.

'''CERTIFICATION CRITERION'''
Interim Final Rule Text:
Automatic log-off. Terminate an electronic session after a predetermined time of inactivity.
Final Rule Text: §170.302(q).
Unchanged.

'''STANDARDS'''
45 CFR 164.308
http://edocket.access.gpo.gov/cfr_2003/octqtr/pdf/45cfr164.308.pdf

'''TEST CRITERIA #'''
§170.302(q)
http://healthcare.nist.gov/docs/170.302.q_AutomaticLogOff_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''None needed. Only documentation of the steps to configure it and demonstrate it are necessary.

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Emergency Access

2010-11-29T23:30:06Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(p)—Emergency Access

'''MU OBJECTIVE'''
Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

'''MU STAGE 1 MEASURE'''
Conduct or review a security risk analysis per 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.

'''CERTIFICATION CRITERION'''
Interim Final Rule Text:
Emergency access. Permit authorized users (who are authorized for emergency situations) to access electronic health information during an emergency.
Final Rule Text: §170.302(p).
Unchanged.

'''STANDARDS'''
45 CFR 164.308
http//:edocket.access.gpo.gov/cfr_2003/octqtr/pdf/45cfr164.308.pdf

'''TEST CRITERIA #'''
§170.302(p)
http://healthcare.nist.gov/docs/170.302.p_EmergencyAccess_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
The devil is in the details of the scripts here as to whether or not the emergency access controls are adequate if a privileged user can grant access to another or if the ordinary user had to be able to break the box to privileged user status without a supervisor providing for that access.

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Access Control

2010-11-29T23:29:28Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(o)—Access Control

'''MU OBJECTIVE'''
Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

'''MU STAGE 1 MEASURE'''
Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.

'''CERTIFICATION CRITERION'''
Interim Final Rule Text:
Access control. Assign a unique name and/or number for identifying and tracking user identity and establish controls that permit only authorized users to access electronic health information.
Final Rule Text: §170.302(o).
Unchanged.

'''STANDARDS'''
45 CFR 164.308
http://edocket.access.gpo.gov/cfr_2003/octqtr/pdf/45cfr164.308.pdf

'''TEST CRITERIA #'''
§170.302(o)
http://healthcare.nist.gov/docs/170.302.o_AccessControl_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
We believe that VistA has this capability already. All of the various security methods and how they are used and access needs some documentation.

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Clinical Decision Support (EH/CAH)

2010-11-29T23:28:56Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.306(c)—Clinical Decision Support

'''MU OBJECTIVE'''
Implement one clinical decision support rule related to a high priority hospital condition along with the ability to track compliance with that rule

'''MU STAGE 1 MEASURE'''
Implement one clinical decision support rule

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.306(c).
(1) Implement rules. Implement automated, electronic clinical decision support rules (in addition to drug-drug and drug-allergy contraindication checking) based on the data elements included in: problem list; medication list; demographics; and laboratory test results.
(2) Notifications. Automatically and electronically generate and indicate in real-time, notifications and care suggestions based upon clinical decision support rules.

'''STANDARDS'''
N/A

'''TEST CRITERIA #'''
§170.306(c)
http://healthcare.nist.gov/docs/170.306.c_ClinicalDecisionSupportIP_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EH/CAH
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Clinical Decision Support (EP)

2010-11-29T23:28:27Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.304(e)—Clinical Decision Support

'''MU OBJECTIVE'''
Implement one clinical decision support rule related to a high priority hospital condition along with the ability to track compliance with that rule

'''MU STAGE 1 MEASURE'''
Implement one clinical decision support rule

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.304(e).
(1) Implement rules. Implement automated, electronic clinical decision support rules (in addition to drug-drug and drug-allergy contraindication checking) based on the data elements included in: problem list; medication list; demographics; and laboratory test results.
(2) Notifications. Automatically and electronically generate and indicate in real-time, notifications and care suggestions based upon clinical decision support rules.

'''STANDARDS'''
N/A

'''TEST CRITERIA #'''
§170.304(e)
http://healthcare.nist.gov/docs/170.304.e_ClinicalDecisionSupportAmb_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EP
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
Reminders of some sorts are already built into VistA instances that can serve to demonstrate this capability. Additional reminders are being developed to support several phases of quality reporting. Please contact Matt King if you are someone who can help. Reminders classes will hopefully be beginning soon as well.

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Capability To Exchange Key Clinical Information (EH/CAH)

2010-11-29T23:27:59Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.306(f)—Exchange Clinical
Information and Summary Record

'''MU OBJECTIVE'''
Capability to exchange key clinical information (for example, discharge summary, procedures, problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically.

'''MU STAGE 1 MEASURE'''
Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information.

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.306(f).
(1) Electronically receive and display. Electronically receive and display a patient’s summary record from other providers and organizations including, at a minimum, diagnostic test results, problem list, medication list, medication allergy list, and procedures in accordance with the standard (and applicable implementation specifications) specified in §170.205(a)(1) or §170.205(a)(2). Upon receipt of a patient summary record formatted according to the alternative standard, display it in human readable format.
(2) Electronically transmit. Enable a user to electronically transmit a patient’s summary record to other providers and organizations including, at a minimum, diagnostic results, problem list, medication list, medication allergy list, and procedures in accordance with:
(i) The standard (and applicable implementation specifications) specified in §170.205(a)(1) or §170.205(a)(2); and
(ii) For the following data elements the applicable standard must be used:
(A) Problems. The standard specified in §170.207(a)(1) or, at a minimum, the version of the standard specified in §170.207(a)(2);
(B) Procedures. The standard specified in §170.207(b)(1) or §170.207(b)(2);
(C) Laboratory test results. At a minimum, the version of the standard specified in §170.207(c); and
(D) Medications. The standard specified in §170.207(d).

'''STANDARDS'''
§170.205(a)(1)
§170.205(a)(2)
§170.207(a)(1)
§170.207(a)(2)
§170.207(b)(1)
§170.207(b)(2)
§170.207(c)
§170.207(d)

'''TEST CRITERIA #'''
§170.306(f)
http://healthcare.nist.gov/docs/170.306.f_ExchangeClinicalinfoSummaryRecordIP_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EH/CAH
| CORE
| WorldVistA, et al
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Capability To Exchange Key Clinical Information (EP)

2010-11-29T23:27:30Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.304(i)—Exchange Clinical Information and Patient Summary Record

'''MU OBJECTIVE'''
Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically.

'''MU STAGE 1 MEASURE'''
Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information.

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.304(i)
(1) Electronically receive and display. Electronically receive and display a patient’s summary record, from other providers and organizations including, at a minimum, diagnostic tests results, problem list, medication list, and medication allergy list in accordance with the standard (and applicable implementation specifications) specified in §170.205(a)(1) or §170.205(a)(2).
Upon receipt of a patient summary record formatted according to the alternative standard, display it in human readable format.
(2) Electronically transmit. Enable a user to electronically transmit a patient summary record to other providers and organizations including, at a minimum, diagnostic test results, problem list, medication list, and medication allergy list in accordance with:
(i) The standard (and applicable implementation specifications) specified in §170.205(a)(1) or §170.205(a)(2); and
(ii) For the following data elements the applicable standard must be used:
(A) Problems. The standard specified in §170.207(a)(1) or, at a minimum, the version of the standard specified in §170.207(a)(2);
(B) Laboratory test results. At a minimum, the version of the standard specified in §170.207(c); and
(C) Medications. The standard specified in §170.207(d).

'''STANDARDS'''(See below)
§170.205(a)(1)
§170.205(a)(2)
§170.205(a)(2)
§170.207(a)(1)
§170.207(a)(2)
§170.207(c)
§170.207(d)

§170.205 Content exchange and vocabulary standards for exchanging electronic health information.

(a) Patient summary record.

(1) The Secretary adopts the following content exchange standards for the purposes of electronically exchanging a patient summary record or to use in creating an electronic copy of a patient summary record:

(i) Standard. Health Level Seven Clinical Document Architecture (CDA) Release 2, Level 2 Continuity of Care Document (CCD) (incorporated by reference in §170.299).

(ii) Alternative standard. ASTM E2369 Standard Specification for Continuity of Care Record and Adjunct to ASTM E2369 (incorporated by reference in §170.299).

(2) The Secretary adopts the following vocabulary standards for the purposes of specifying the code set, terminology, or nomenclature to use to represent health information included in a patient summary record:

(i) Problem list.

(A) Standard. The code set specified for the conditions specified at 45 CFR 162.1002(a)(1).

(B) Alternative standard. International Health Terminology Standards Development Organization (IHTSDO) Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT®) July 2009 version (incorporated by reference in §170.299).

(ii) Procedures.

(A) Standard. The code set specified at 45 CFR 162.1002(a)(2).

(B) Alternative standard. The code set specified at 45 CFR 162.1002(a)(5).

(iii) Laboratory orders and results.

(A) Standard. Logical Observation Identifiers Names and Codes (LOINC®) version 2.27, when such codes were received within an electronic transaction from a laboratory (incorporated by reference in §170.299).

(B) [Reserved]

(iv) Medication list.

(A) Standard. Any code set by an RxNorm drug data source provider that is identified by the United States National Library of Medicine as being a complete data set integrated within RxNorm.

(B) [Reserved]

(b) Drug formulary check. The Secretary adopts the following content exchange standard for transmitting formulary and benefits information between prescribers and Medicare Part D sponsors.

(1) Standard. Drug formulary and benefits information must be transmitted in accordance with 42 CFR 423.160(b)(5).

(2) [Reserved]

(c) Electronically transmitting prescription information.

(1) The Secretary adopts the following content exchange standard to provide for the transmission of a prescription or prescription-related information.

(i) Standard. An electronic prescription for a Medicare Part D covered drug that is prescribed for a Medicare Part D eligible individual must be transmitted in accordance with 42 CFR 423.160(b)(2)(ii), in all other circumstances, if consistent with applicable state and other Federal law, electronic prescriptions may be transmitted in accordance with 42 CFR 423.160(b)(2)(ii) or using the NCPDP SCRIPT Standard, Implementation Guide, Version 10.6 (incorporated by reference in §170.299).

(ii) [Reserved]

(2) The Secretary adopts the following vocabulary standard for the purposes of specifying the code set to use to represent health information included in electronic prescriptions.

(i) Standard. Any code set by an RxNorm drug data source provider that is identified by the United States National Library of Medicine as being a complete data set integrated within RxNorm.

(ii) [Reserved]

(d) Electronically exchange administrative transactions. The Secretary adopts the following content exchange standards and associated implementation specifications for the following electronic transactions.

(1) Standard and implementation specifications. An eligibility for a health plan transaction as defined at 45 CFR 162.1201 must be conducted in accordance with:

(i) 45 CFR 162.1202(b) or for the period on and after January 1, 2012, in accordance with 45 CFR 162.1202(c); and

(ii) the operating rules specified in Phase 1 of the Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE) (incorporated by reference in §170.299).

(2) Standard and implementation specifications. Eligibility inquiry and response transactions between dispensers and Part D sponsors for Part D prescription drugs must be conducted in accordance with 42 CFR 423.160(b)(3)(ii). (3) Standard and implementation specifications. A health care claims or equivalent encounter information transaction as defined at 45 CFR 162.1101 must be conducted in accordance with 45 CFR 162.1102(b) or for the period on and after January 1, 2012, in accordance with 45 CFR 162.1102(c).

(e) Electronically exchange quality reporting information. The Secretary adopts the following content exchange standard and implementation specification for quality reporting.

(1) Standard. The CMS Physician Quality Reporting Initiative (PQRI) 2008 Registry XML Specification (incorporated by reference in §170.299).

(2) Implementation specification. Physician Quality Reporting Initiative Measure Specifications Manual for Claims and Registry (incorporated by reference in §170.299).

(f) Electronic submission of lab results to public health agencies.

(1) The Secretary adopts the following content exchange standard for the electronic submission of lab results to public health agencies.

(i) Standard. HL7 2.5.1(incorporated by reference in §170.299).

(ii) [Reserved]

(2) The Secretary adopts the following vocabulary standard for the purposes of representing lab results in an electronic submission to public health authorities.

(i) Standard. Logical Observation Identifiers Names and Codes (LOINC®), version 2.27, when such codes were received within an electronic transaction from a laboratory (incorporated by reference in §170.299).

(ii) [Reserved]

(g) Electronic submission to public health agencies for surveillance or reporting. The Secretary adopts the following content exchange standards for electronic submission to public health agencies for surveillance or reporting:

(1) Standard. HL7 2.3.1(incorporated by reference in §170.299).

(2) Alternative standard. HL7 2.5.1(incorporated by reference in §170.299).

(h) Electronic submission to immunization registries.

(1) The Secretary adopts the following content exchange standards for electronic submission to immunization registries:

(i) Standard. HL7 2.3.1 (incorporated by reference in §170.299).

(ii) Alternative Standard. HL7 2.5.1 (incorporated by reference in §170.299).

(2) The Secretary adopts the following vocabulary standard for electronic submissions to immunization registries.

(i) Standard. HL7 Standard Code Set CVX - Vaccines Administered, July 30, 2009 version (incorporated by reference in §170.299).

(ii) [Reserved]

§170.207 Vocabulary standards for representing electronic health information. The Secretary adopts the following code sets, terminology, and nomenclature as the vocabulary standards for the purpose of representing electronic health information.

(a) Problems.

(1) Standard. The code set specified at 45 CFR 162.1002(a)(1) for the indicated conditions.

(2) Standard. International Health Terminology Standards Development Organization (IHTSDO) Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT®) July 2009 version (incorporated by reference in §170.299).

(b) Procedures. (1) Standard. The code set specified at 45 CFR 162.1002(a)(2).

(2) Standard. The code set specified at 45 CFR 162.1002(a)(5).

(c) Laboratory test results. Standard. Logical Observation Identifiers Names and Codes (LOINC®) version 2.27, when such codes were received within an electronic transaction from a laboratory (incorporated by reference in §170.299).

(d) Medications. Standard. Any source vocabulary that is included in RxNorm, a standardized nomenclature for clinical drugs produced by the United States National Library of Medicine.

(e) Immunizations. Standard. HL7 Standard Code Set CVX - Vaccines Administered, July 30, 2009 version (incorporated by reference in §170.299).

(f) Race and Ethnicity. Standard. The Office of Management and Budget Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity, Statistical Policy Directive No. 15, October 30, 1997 (available at http://www.whitehouse.gov/omb/rewrite/fedreg/ombdir15.html). [The hyperlink returns a message "404 Page Not Found". This problem was reported to ONC.Certification@hhs.gov on 08/23/2010.]

'''TEST CRITERIA #'''
§170.304(i)
http://healthcare.nist.gov/docs/170.304.i_ExchangeClinicalinforPatientSummaryRecordAmb_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EP
| CORE
| WorldVistA, et al
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''

(1) This capability will be provided by the code coming from the CCR-CCD project. The latest project code can be found on http://trac.opensourcevista.net and there are calls almost every Tuesday night at 9 PM Eastern to work on the project. You can sign up to receive notices of the meetings at http://groups.google.com/group/ccd-ccr-project?hl=en . Both a CCR and CCD level 2 are being produced at this time and we are hoping that there will be the capability of transmitting a CCD level 3 in the future as that work is underway. WorldVistA will be submitting a recommendation to the ONCHIT to use both the CCR and CCD as standards for transmission of these health summaries. The production of an XSLT transform to create a CCD level 3 from a CCR, which is the current goal of some work being done by Ken Miller of Solventus as an open source project funded by Oroville Hopital in California, should make this easily possible for healthcare providers.

(2)This will also be covered by the CCR-CCD project. Either a CCR or CCD level 2 is something that can be extracted at this time. (see above) This particular standard does not specify how the transmission must be done. It is clear that it must be encrypted but it is not clear how it may be transmitted. Then NHIN is mentioned but there it is not clear that other methods of transport are not allowed such as email with an encrypted attachment. (There is mention that if it is physically transported outside of a healthcare facility, it should be encrypted.)

'''DEVELOPMENT STATUS'''
As Above. The production of a level 3 CCD from a CCR is coming along nicely within the CCR-CCD project and an additional new volunteer who is very knowledgeable has just joined, but more would be welcome. XSLT experience is needed.

The CCD is being produced for lab results but more domains of results need to be added. Help with that would be appreciated.

The work is being done as part of the CCD-CCR project. We do not know if the CCD or the CCR will be the ultimate medium of exchange but for the moment, we need to be able to store and display either one.

Some additional work is needed to make that seamless.

Largely, the document received in XML format needs to be displayed in a browser along with the file that "translates" it into a human readable format. This involves putting the document as received in the same directory as the file that allows it to be displayed and opening it in a browser.

Documents received are not yet able to be absorbed to populate other files such as the lab file and it is clear that not all physicians what that. Portions of CCR can be parsed into XPath elements (I have to check if the CCD can be as well) However, the EHR will eventually most likely be required to be capable of absorbing the data out of the CCR or CCD and putting it into existing files in VistA other than these new files storing the XPath and variables. We will need to be able to indicate that that data is from another source. Problems, Allergies, Medications are top priorities from this.

The best we can recommend to help with this is to help out in the CCR-CCD project and make yourself know to George Lilly, Dave Whitten or Nancy Anthracite as someone who can help.

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Drug-Drug Drug-Allergy Checks

2010-11-29T23:26:33Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(a)—Drug-Drug, Drug-Allergy, Drug-Formulary Checks

'''MU OBJECTIVE'''
Implement drug-drug and drug-allergy interaction checks

'''MU STAGE 1 MEASURE'''
The EP/eligible hospital/CAH has enabled this functionality for the entire EHR reporting period

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.302(a).
(1) Notifications. Automatically and electronically generate and indicate in real-time, notifications at the point of care for drug- drug and drug-allergy contraindications based on medication list, medication allergy list, and computerized provider order entry (CPOE).
(2) Adjustments. Provide certain users with the ability to adjust notifications provided for drug-drug and drug-allergy interaction checks.

'''STANDARDS'''
N/A

'''TEST CRITERIA #'''
§170.302 (a)
http://healthcare.nist.gov/docs/170.302.a_DrugDrugDrugAllergy_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| CORE
| Oroville
| In development
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''Although VistA does this now, the need for other interaction checking will be coming and the ability of the purely open source VistA to do this will be leaving because the VA is implementing the use of FirstData and will not be maintaining the interactions in the National Drug File. ePrescribing that is being built by Oroville will need to pick up that function for both patients who have new prescriptions and those who don't.

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Computerized Provider Order Entry (EH/CAH)

2010-11-29T23:25:44Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.306(a)—Computerized Provider Order Entry

'''MU 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

'''MU 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

'''CERTIFICATION CRITERION'''
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.

'''STANDARDS'''
N/A

'''TEST CRITERIA #'''
§170.306(a)
http://healthcare.nist.gov/docs/170.306.a_CPOEIP_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EH/CAH
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''

I believe Matt handled this by sending the consult to someone assigned the job of sending the referral to the consultant selected. This might be by fax, etc. I believe consult services are set up and referral documents set up using a template that has some prepopulated objects in it - demographics, etc., and the person responsible for seeing that they get sent out is sent an alert. The the "consult service" is actually a group/person set up to process the consult. Various requirements can be set up for each sort of "consult service," like certain lab results of pulmonary funcion test results, EKGs, etc. Much of this can be set up under the Consult Management CMRC MGR option using Setup a consult service (SS).

Consult responses are set up as special TIU notes for scanned responses and the provider receiving the consult has a special note title to process it and is responsible for setting the consult status to completed.

Detailed documentation for how this is done with other variations needs to be entered here.

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Computerized Provider Order Entry (EP)

2010-11-29T23:25:20Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.304(a)—Computerized Provider Order Entry

'''MU 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

'''MU 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

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.304(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.

'''STANDARDS'''
N/A

'''TEST CRITERIA #'''
§170.304(a)
http://healthcare.nist.gov/docs/170.304.a_CPOE_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EP
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Electronically Exchange Prescription Information

2010-11-29T23:24:54Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.304(b)—Electronically Exchange Prescription Information

'''MU OBJECTIVE'''
Generate and transmit permissible prescriptions electronically (eRx)

'''MU STAGE 1 MEASURE'''
(EP only) More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.304(b).
Electronic prescribing. Enable a user to electronically generate and transmit prescriptions and prescription-related information in accordance with:
(1) The standard specified in §170.205(b)(1) or §170.205(b)(2);
and
(2) The standard specified in 170.207(d).

'''STANDARDS'''
§170.205(b)(1)
§170.205(b)(2)
170.207(d)

'''TEST CRITERIA #'''
§170.304 (b)
http://healthcare.nist.gov/docs/170.304.b_ExchangePrescriptionInformation_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EP
| CORE
| Oroville
| In development
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
See the drug interaction and allergy checking item 2 for a beginning to this discussion.

'''DEVELOPMENT STATUS''' Speaking to the best of my knowledge (Nancy Anthracite), this is under development at Oroville hospital for eventual open source release. It will be required to subscribe to a service as multiple proprietary databases are involved whether or not ePrescribing is ever fully developed as a separate service exclusively for VistA as entirely open source software unless a convenient interface a totally free solution such as Allscripts is developed. It is my understanging that Allscripts does not approve of screen scraping, etc. to make that interface possible so the use of the Oroville software seems to be the most reasonable solution. The initial phase is in testing for release. When Oroville will release it is in their court. It will be necessary to use it or something else to achieve Meaningful Use to my knowledge as I don't know of any other group working on an open source solution. We anticipate that the drug interaction that is supported by the national drug file will disappear as the VA moves to using FirstData, so the ePrescribing service or some alternative will be needed for that. There is a potential for doing local drug interaction checking with the ePrescribing software which will be another powerful incentive to subscribe to the service.

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Electronic Copy of Health Information (EH/CAH)

2010-11-29T23:24:06Z

Peterbodtke: updated NIST test script version number

MU Stage1 Final Rule - Electronic Copy of Health Information (EP)

2010-11-29T23:23:31Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.304(f)—Electronic Copy of Health Information

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

'''MU STAGE 1 MEASURE'''
More than 50% of all patients of the EP or the inpatient or emergency departments of the eligible hospital or CAH (POS 21 or 23) who request an electronic copy of their health information are provided it within 3 business days

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.304(f).
Electronic copy of health information. Enable a user to create an electronic copy of a patient’s clinical information, including, at a minimum, diagnostic test results, problem list, medication list, and medication allergy list in:
(1) Human readable format; and
(2) On electronic media or through some other electronic means in accordance with:
(i) The standard (and applicable implementation specifications) specified in §170.205(a)(1) or §170.205(a)(2); and
(ii) For the following data elements the applicable standard must be used:
(A) Problems. The standard specified in §170.207(a)(1) or, at a minimum, the version of the standard specified in §170.207(a)(2);
(B)Laboratory test results. At a minimum, the version of the standard specified in §170.207(c); and
(C) Medications. The standard specified in §170.207(d).

'''STANDARDS'''
§170.205(a)(1)
§170.205(a)(2)
§170.207(a)(1)
§170.207(a)(2)
§170.207(c)
§170.207(d)

'''TEST CRITERIA #'''
§170.304(f)
http://healthcare.nist.gov/docs/170.304.f_ElectronicCopyOfHealthInformation_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EP
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Electronic Copy of Discharge Information (EH/CAH)

2010-11-29T23:23:06Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.306(e)—Electronic Copy of Discharge Information

'''MU OBJECTIVE'''

Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request

'''MU STAGE 1 MEASURE'''
More than 50% of all patients who are discharged from an eligible hospital or CAH’s inpatient department or emergency department (POS 21 or 23) and who request an electronic copy of their discharge instructions are provided it

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.306(e).
Electronic copy of discharge instructions. Enable a user to create an electronic copy of the discharge instructions for a patient, in human readable format, at the time of discharge on electronic media or through some other electronic means.

'''STANDARDS'''
N/A

'''TEST CRITERIA #'''
§170.306(e)
http://healthcare.nist.gov/docs/170.306.e_ElectronicCopyofDischargeInstructions_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EH/CAH
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS''' The real time extraction of a CCR that can be done thanks to the CCR-CCD project will help a great deal with this. Health Summary documents that are part of VistA can help with this as well. The Discharge summary is not currently part of the CCR but it might be adapted to extract that as a "Comment" if desired.

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Clinical Summaries

2010-11-29T23:22:29Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.304(h)—Clinical Summaries

'''MU OBJECTIVE'''
Provide clinical summaries for patients for each office visit.

'''MU STAGE 1 MEASURE'''
Clinical summaries provided to patients for more than 50% of all office visits within 3 business days.

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.304(h).
Clinical summaries. Enable a user to provide clinical summaries to patients for each office visit that include, at a minimum, diagnostic test results, problem list, medication list, and medication allergy list. If the clinical summary is provided electronically it must be:
(1) Provided in human readable format; and
(2) Provided on electronic media or through some other electronic means in accordance with:
(i) The standard (and applicable implementation specifications) specified in §170.205(a)(1) or §170.205(a)(2); and
(ii) For the following data elements the applicable standard must be used:
(A) Problems. The standard specified in §170.207(a)(1) or, at a minimum, the version of the standard specified in §170.207(a)(2);
(B)Laboratory test results. At a minimum, the version of the standard specified in §170.207(c); and
(C) Medications. The standard specified in §170.207(d).

'''STANDARDS'''
§170.205(a)(1)
§170.205(a)(2)
§170.207(a)(1)
§170.207(a)(2)
§170.207(c)
§170.207(d)

'''TEST CRITERIA #'''
§170.304(h)
http://healthcare.nist.gov/docs/170.304.h_ClinicalSummaries_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EP
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
The CCR can be extracted using the code in development and available on the Trac server for download. This will provide what the provider needs that is machine and human readable, however, a patient portal that is secure and easy to deploy for delivery of the documents would be a plus. Hopefully KRM will be providing a solution that can be used. Other open source solutions would be welcome. Most of the personal health records will consume a CCR.

An effort to convert a CCR to a CCD and to a QRDA document is underway as part of the CCR-CCD project. Volunteers are always welcome on that project. Right now the project includes others that do not even use VistA such as the folks supporting OpenEMR, another open source medical records system and what is being developed as broad applications.

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Smoking Status

2010-11-29T23:22:00Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(f)—Smoking Status

'''MU OBJECTIVE'''
Record smoking status for patients 13 years old or older

'''MU STAGE 1 MEASURE'''
More than 50% of all unique patients 13 years old or older seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have smoking status recorded as structured data

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.302(g).
Smoking status. Enable a user to electronically record, modify, and retrieve the smoking status of a patient. Smoking status types must include: current every day smoker; current some day smoker; former smoker; never smoker; smoker, current status unknown; and unknown if ever smoked.

'''STANDARDS'''
N/A

'''TEST CRITERIA #'''
§170.302 (g)
http://healthcare.nist.gov/docs/170.302.g_smokingstatus_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| CORE
| Matt King
| Design phase
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''Matthew King is spearheading the effort to build reminders that will satisfy this and server to provide data for the quality reporting measures that require information about smoking status and interventions. He would like any CACs who are willing to help to contact him.

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Maintain Active Medication Allergy List

2010-11-29T23:21:20Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(d)—Maintain Active Medication Allergy List

'''MU OBJECTIVE'''
Maintain active medication allergy list

'''MU STAGE 1 MEASURE'''
More than 80% of all unique patients 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 entry (or an indication that the patient has no known medication allergies) recorded as

'''CERTIFICATION CRITERION'''
Interim Final Rule Text:
Maintain active medication allergy list. Enable a user to electronically record, modify, and retrieve a patient’s active medication allergy list as well as medication allergy history for longitudinal care.
Final Rule Text: Unchanged
Now §170.302(e).

'''STANDARDS'''
N/A

'''TEST CRITERIA #'''
§170.302 (e)
http://healthcare.nist.gov/docs/170.302.e_allergylist_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''

It is very likely that the current allergy list will satisfy this criteria but there is also a possibility that it will need to be modified to be coded correctly, i.e., for ePrescribing or for RxNorm compatibility. Also, the VA is standardizing this list and we no longer receive that information except by extracting it from the VA Demos that we receive or potentially from a FOIA copy of VistA. Nancy Anthracite has a FOIA request in for the updates with OI&T and another is pending with VHA.

'''DEVELOPMENT STATUS'''
Volunteers needed to check to be sure the audit logs for allergies satisfy all of the criteria necessary for auditing and to see if the historical changes to the allergies such as "Entered in Error" can be retrieved by a user or if a tool needs to be built to do that.

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Maintain Active Medication List

2010-11-29T23:20:43Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(c)—Maintain Active Medication List

'''MU OBJECTIVE'''
Maintain active medication list

'''MU STAGE 1 MEASURE'''
More than 80% of all unique patients 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 entry (or an indication that the patient is not currently prescribed any medication) reco

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.302(d).
Maintain active medication list. Enable a user to electronically record, modify, and retrieve a patient’s active medication list as well as medication history for longitudinal care.

'''STANDARDS'''
The medications will ultimately need to be coded with RxNorm although not for this requirement at this time

'''TEST CRITERIA #'''
§170.302 (d)
http://healthcare.nist.gov/docs/170.302.d_medicationlist_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
Although VistA does this natively, the integration with an ePrescibing service means that major work will need to be done to bring medications lists back in from the ePrescribing service and to integrate them with the VistA medication lists. This is being done as part of the ePrescribing effort being funded and eventually released by Oroville hospital. There will be continued effort needed to keep this project updated, moved into the next phases and maintained and the contribution of the whole community to this effort will be required.

'''DEVELOPMENT STATUS'''
Work to integrate RxNorm into VistA has begun for PQRI (quality) reporting which requires RxNorm coding. Fortunately the VUIDs are mapped to the RxNorm codes. Unfortunately, there is no guarantee that this will continue as the VA is moving to FirstData, but there is an effort to get the FirstData codes mapped to RxNorm as well so they can be cross-walked. Potential volunteers for that work may contact George Lilly or Nancy Anthracite for help finding out what they could do to help.

A entry for taking "no medications" needs to be available as well for Meaningful Use.

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Maintain Up-To- Date Problem List

2010-11-29T23:20:16Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.302(b)—Maintain Up-To- Date Problem List

'''MU OBJECTIVE'''
Maintain an up-to-date problem list

'''MU STAGE 1 MEASURE'''
More than 80% of all unique patients 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 entry or an indication that no problems are known for the patient recorded as structured

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.302(c).
Final rule text remains the same as Interim Final Rule text, except for references to adopted standards, which have been changed.

'''STANDARDS'''
N/A

'''TEST CRITERIA #'''
§170.302(c)
http://healthcare.nist.gov/docs/170.302.c_problemlist_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| CORE
| Oroville
| In development
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''

ICD9 is currently the coding used for the problem list, but ICD 10 will be required in the future. Fortunately for us this is something the VA will have to tackle as they bill. The concern is that there will be a delay in releasing the code for this but since WorldVistA had finally managed to negotiate the release of the lexicon files from the VA in a timely fashion, hopefully there is a mechanism permanently in place for this to be done smoothly. This is not the whole story, however, as there is a one to many relationship between ICD9 and SNOMED and ICD10.

In addition, there is a problem list coding effort going on between Kaiser Premanante and the VA so it is possible they will come up with their own standard for coding problems and will not follow what is required by Meaningful Use. However, considering that they bill the insurance companies and Medicare as well (?), presumably the VA will need to conform.

'''DEVELOPMENT STATUS'''
Step by step documentation for how problems are entered and edited and coded is needed. Most will need to install the ICD9, CPT and SNOMED codes and the recommended method for doing that by the VA is to update the Lexicon files and the CPT code files with ICD 9 codes included all at once. Problem coding with SNOMED is not done in VistA at this time. WorldVistA has an agreement with the VA and AMA that allows purchase of the CPT codes from the AMA and a kit from WorldVistA. The kit contains the VA files. Contact Nancy Anthracite for more information. nancy at worldvista dot org.

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Record and Chart Vital Signs

2010-11-29T23:10:47Z

Peterbodtke: updated NIST test script version number

''SECTION # '''
Section 170.302(e)—Record and Chart Vital Signs

'''MU OBJECTIVE'''
Record and chart changes in vital signs:
- Height
- Weight
- Blood pressure
- Calculate and display BMI
(Plot and display growth charts for children 2-20 years, including BMI)

'''MU STAGE 1 MEASURE'''
For more than 50% of all unique patients age 2 and over seen by the EP or admitted to eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23), height, weight and blood pressure are recorded as structured data

'''CERTIFICATION CRITERION'''
Interim Final Rule Text:
(1)Vital signs. Enable a user to electronically record, modify, and retrieve a patient’s vital signs including, at a minimum, the height, weight, blood pressure, temperature, and pulse.
(2)Calculate body mass index. Automatically calculate and display body mass index (BMI) based on a patient’s height and weight.
(3) Plot and display growth charts. Plot and electronically display, upon request, growth charts for patients 2–20 years old.
Final Rule Text: §170.302(f).
(1)Vital signs. Enable a user to electronically record, modify, and retrieve a patient’s vital signs including, at a minimum, height, weight, and blood pressure.
(2) Unchanged
(3) Unchanged

'''STANDARDS'''
N/A

'''TEST CRITERIA #'''
§170.302 (f) 
http://healthcare.nist.gov/docs/170.302.f.1_vitalsigns_v1.1.pdf 
http://healthcare.nist.gov/docs/170.302.f.2_BMI_v1.1.pdf 
http://healthcare.nist.gov/docs/170.302.f.3_growthcharts_v1.1.pdf 
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| All
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

There is a PHP based application already built for use with VistA but better documentation and installation instructions are needed. It is in use in Clinica Adelante and Nancy Anthracite is looking for volunteers to work on the documentation and updating the code packages it depends on if needed for PHP and JB chart, etc. The MUMPS code may need a KIDS build for the routines although they may already be in the package. The BMI calculations needs to be check as there has been one report that they are not correct. One or more Volunteers is needed.

For international use, data files need to have the WHO data added and verified. That is partially done but needs more work.

Here is the current documentation, which is sparse.

Pediatric Growth Charts

wget http://downloads.sourceforge.net/phpgrowthcharts/php-growth-charts-1.1.zip
wget http://downloads.sourceforge.net/phpgrowthcharts/php-growth-charts-1.1.tar.gz

As root:
apt-get install apache2
apt-get install php5 php5-gd php5-cli php5-common libapache2-mod-php5
cd /etc/apache2/mods-enabled
cp /etc/apache2/mods-available/php5.conf /etc/apache2/mods-enabled/
cp /etc/apache2/mods-available/php5.load /etc/apache2/mods-enabled/
/etc/init.d/apache2 restart

If you don't have this directory, make it and unpack the attached file into it

truetype.tgz

/usr/X11R6/lib/X11/fonts/

Now that Apache is in, check to see if you can connect to your server and get a report that says "It Works".
If not, check the error log in /var/log/apache2/error.log to see what the problem is. Most likely, you need to open port 80 on you server or your ISP does not allow connections on port 80.

Now, for Debian, become root and load up the PHP Growth Chart application

cd /var/www
mkdir PGC
cd PGC
cp /home/user/php-growth-charts-1.1.tar.gz ./
tar -xzvf php-growth-charts-1.1.tar.gz
php-growth-charts-1.1.tar.gz

To make this all work with ssl (i.e., https) instead
on a port that will not interfere with the java application server for GUI Registration

To enable ssl on Debian, with Apache2 installed which normally already has mod-ssl

run these commands to make a self signed key: You may use a commercial signer if you prefer.
Create a private key

THERE ARE TWO WAYS TO DO IT BELOW:

FIRST WAY

Apache2 Server Key Commands

openssl genrsa -des3 -out server.key 1024
openssl req -new -x509 -nodes -sha1 -days 365 -key server.key -out server.crt

SECOND WAY

$ openssl genrsa -des3 -out server.key 1024

If you want ot generate server.pem
openssl rsa -in server.key -out server.pem but in my case, I don't

Create a self-signed Certificate (X509 structure) with the RSA key you just created (output will be PEM formatted):

$ openssl req -new -x509 -nodes -sha1 -days 365 -key server.key -out server.crt

You should now have two files: server.key and server.crt. Note pass phrase on edu2 is worldvista257

The following files shoud be altered from the defaults

1. /etc/apach2/apache2.conf

Add the following lines at the end:
DocumentRoot /var/www
ServerAdmin webmaster@localhost
#ServerName edu2.opensourcevista.net
SSLEngine On
SSLCertificateFile /etc/apache2/server.crt
SSLCertificateKeyFile /etc/apache2/server.key

2. The ports file. I chose a port other than 80 to avoid interfering with the GUI Registration Application
Change Listen 80

Listen 9500

3. cp all of the files beginnig with ssl from /etc/apache2/mods-available/ to /etc/apache2/mods-enabled/

cp /etc/apache2/mods-available/ssl* /etc/apache/mods-enabled/

My mods-enabled directory now looks like this:
/etc/apache2# ls mods-enabled/
alias.load authz_groupfile.load cgi.load mime.load setenvif.load
auth_basic.load authz_host.load dir.conf negotiation.load ssl.conf
authn_file.load authz_user.load dir.load php5.conf ssl.load
authz_default.load autoindex.load env.load php5.load status.load

The apache2 directory when I am done looks like this, and the sites-enabled directory is empty.

/etc/apache2# ls -al
total 100
drwxr-xr-x 7 root root 4096 Jul 15 22:14 .
drwxr-xr-x 55 root root 4096 Jul 15 21:46 ..
-rw-r----- 1 root root 0 Jul 15 02:12 =
-rw-r----- 1 root root 24370 Jul 15 23:58 apache2.conf
-rw-r----- 1 root root 24178 Jul 15 22:14 apache2.confBU
drw-r----- 2 root root 4096 Jul 4 18:42 conf.d
-rw-r----- 1 root root 895 Mar 27 12:58 envvars
-rw-r----- 1 root root 0 Jul 15 22:11 httpd.conf
drw-r----- 2 root root 4096 Jul 15 22:50 mods-available
drw-r----- 2 root root 4096 Jul 15 23:59 mods-enabled
-rw-r----- 1 root root 13 Jul 15 23:52 ports.conf
-rw-r----- 1 root root 1391 Jul 15 04:24 server.crt
-rw-r----- 1 root root 963 Jul 15 04:23 server.key
drw-r----- 2 root root 4096 Jul 15 14:53 sites-available
drw-r----- 2 root root 4096 Jul 15 21:57 sites-enabled

Install the PGCHTML.KID
Then
worldvista:~# gtm

GTM>S DUZ=9

GTM>D ^XUP

Setting up programmer environment
This is a TEST account.

Terminal Type set to: C-VT320

Select OPTION NAME:
GTM>D ^XPAREDIT

--- Edit Parameter Values ---

Select PARAMETER DEFINITION NAME: GMRV PED
1 GMRV PED GROWTH CHART FOLDER Pediatric Growth Chart Directory
2 GMRV PED GROWTH CHART SERVER Pediatric Growth Chart HTML Server
CHOOSE 1-2: 1 GMRV PED GROWTH CHART FOLDER Pediatric Growth Chart Directory

-- Setting GMRV PED GROWTH CHART FOLDER for System: BETA.VISTA-OFFICE.ORG --
Value: /var/www/PGC

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''
(none)

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Record Demographics (EH/CAH)

2010-11-29T23:09:20Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.306(b)—Record Demographics

'''MU OBJECTIVE'''
Record demographics
- Preferred language
- Gender race
- Ethnicity
- Date of birth
- Date and preliminary cause of death in the event of mortality in the eligible hospital or CAH (Eligible Hospital/CAH Only)

'''MU STAGE 1 MEASURE'''
More than 50% of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have demographics recorded as structured data

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.306(b).
Record demographics. Enable a user to electronically record, modify, and retrieve patient demographic data including preferred language, gender, race, ethnicity, date of birth, and date and preliminary cause of death in the event of mortality. Enable race and ethnicity to be recorded in accordance with the standard specified at §170.207(f).

'''STANDARDS'''
§170.207(f)
http://www.whitehouse.gov/omb/fedreg_1997standards/

'''TEST CRITERIA #'''
§170.306 (b)
http://healthcare.nist.gov/docs/170.306.b_RecordDemographicsIP_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EH/CAH
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''
(Add details here)

'''PREVIOUS NOTES'''

'''DEVELOPMENT STATUS'''
(Add details here)

'''ACTION ITEMS / NEXT STEPS'''
(Add details here)

'''OPEN ISSUES / QUESTIONS'''
(Add details here)

MU Stage1 Final Rule - Record Demographics (EP)

2010-11-29T23:01:07Z

Peterbodtke: updated NIST test script version number

'''SECTION # '''
Section 170.304(c)—Record Demographics

'''MU OBJECTIVE'''
Record demographics:
• preferred language
• gender
• race
• ethnicity
• date of birth

'''MU STAGE 1 MEASURE'''
More than 50% of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have demographics recorded as structured data

'''CERTIFICATION CRITERION'''
Final Rule Text: §170.304(c).
Record demographics. Enable a user to electronically record, modify, and retrieve patient demographic data including preferred language, gender, race, ethnicity, and date of birth. Enable race and ethnicity to be recorded in accordance with the standard specified at 170.207(f).

'''STANDARDS'''
170.207(f)
http://www.whitehouse.gov/omb/fedreg_1997standards/

'''TEST CRITERIA #'''
§170.304(c)
http://healthcare.nist.gov/docs/170.304.c_RecordDemographicsAmb_v1.1.pdf
{| class="grey" border="1" cellpadding="2"
! USERS
! CORE / MENU
! SOLUTION DEVELOPERS
! STATUS
|-
| EP
| CORE
| TBD
| TBD
|}
----
'''SOLUTION DESIGN / TECHNOLOGY'''
(Add details here)

'''SOLUTION COMPONENTS'''
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

'''DEPENDENCIES'''
(Add details here)

'''COMMENTS / NOTES'''

At a minimum, the values in following three sections (Race, Ethnicity, Language) must be supported in some way for certification testing.

Race 
- American Indian or Alaska Native 
- Asian 
- Black or African American 
- Native Hawaiian or Other Pacific Islander 
- White 

(the above race values are mentioned in the NIST test criteria. Peter Bodtke)

Ethnicity: 
- Hispanic or Latino 
- Not Hispanic or Latino 

(the above ethnicity values are mentioned in the NIST test criteria. Peter Bodtke)

Language: 
English 
Japanese 
French 
Italian 
Portuguese 
Russian 

(the above ethnicity values are mentioned in the NIST test criteria. Peter Bodtke)

[Below Nancy Anthracite has noted the inconsistencies between the NIST test criteria demographic values (referenced with a broken link and described as "OMB Standards for Maintaining, Collecting, and Presenting Federal Data") and data provided as part of the Physician Quality Reporting Initiative program.]

Race and ethnicity required for quality reporting has not been harmonized by with the Meaningful use requirements by the Office of the National Coordinator for Health IT. A query regarding this has been sent to the ONC.
In general, there has been general movement in the direction of harmonization but this seems to have escaped scrutiny.

1. VistA does not record preferred language at this point and it will be desirable to pick some sort of reasonable standard list of languages to standardize against across the community of VistA users. Also, to my mind just preferred language is not enough. With requirements for translators to be provided in certain circumstances, it is not enough to know, for instance, if Spanish is the preferred language without knowing if a translator is need and if the patient will provide a translator, so this sounds simple, but it is not so simple. This is worth discussing in the community to get suggestions as it would be desirable to end up with some computable data, not just a free text field to fill this requirement.

2. Race and Ethnicity was defined by the ONC for Meaningful Use, but so was quality reporting and the race and ethnicity required for quality reporting is daunting. I am happy to see that race has been expanded to stop using just various Hispanic peoples and not much else, but recording 900+ of what I would think is not race and ethnicity but ethnicity one and ethnicity two choices with no guidance how to handle those of mixed "race" seems rather ridiculous but even more disturbing, and invasion of privacy. This has been brought to the attention of the ONC but there has been no response to a query about that. In the meantime, you can see what the requirements for Quality Reporting are in the following two lists of race and ethnicity

Race:
American Indian or Alaska Native, American Indian, Abenaki, Algonquian, Apache, Chiricahua, Fort Sill Apache, Jicarilla Apache, Lipan Apache, Mescalero Apache, Oklahoma Apache, Payson Apache, San Carlos Apache, White Mountain Apache, Arapaho, Northern Arapaho, Southern Arapaho, Wind River Arapaho, Arikara, Assiniboine, Assiniboine Sioux, Fort Peck Assiniboine Sioux, Bannock, Blackfeet, Brotherton, Burt Lake Band, Caddo, Oklahoma Cado, Cahuilla, Agua Caliente Cahuilla, Augustine, Cabazon, Los Coyotes, Morongo, Santa Rosa Cahuilla, Torres-Martinez, California Tribes, Cahto, Chimariko, Coast Miwok, Digger, Kawaiisu, Kern River, Mattole, Red Wood, Santa Rosa, Takelma, Wappo, Yana, Yuki, Canadian and Latin American Indian, Canadian Indian, Central American Indian, French American Indian, Mexican American Indian, South American Indian, Spanish American Indian, Catawba, Cayuse, Chehalis, Chemakuan, Hoh, Quileute, Chemehuevi, Cherokee, Cherokee Alabama, Cherokees of Northeast Alabama, Cherokees of Southeast Alabama, Eastern Cherokee, Echota Cherokee, Etowah Cherokee, Northern Cherokee, Tuscola, United Keetowah Band of Cherokee, Western Cherokee, Cherokee Shawnee, Cheyenne, Northern Cheyenne, Southern Cheyenne, Cheyenne-Arapaho, Chickahominy, Eastern Chickahominy, Western Chickahominy, Chickasaw, Chinook, Clatsop, Columbia River Chinook, Kathlamet, Upper Chinook, Wakiakum Chinook, Willapa Chinook, Wishram, Chippewa, Bad River, Bay Mills Chippewa, Bois Forte, Burt Lake Chippewa, Fond du Lac, Grand Portage, Grand Traverse Band of Ottawa-Chippewa, Keweenaw, Lac Courte Oreilles, Lac du Flambeau, Lac Vieux Desert Chippewa, Lake Superior, Leech Lake, Little Shell Chippewa, Mille Lacs, Minnesota Chippewa, Ontonagon, Red Cliff Chippewa, Red Lake Chippewa, Saginaw Chippewa, St. Croix Chippewa, Sault Ste. Marie Chippewa, Sokoagon Chippewa, Turtle Mountain, White Earth, Chippewa Cree, Rocky Boy's Chippewa Cree, Chitimacha, Choctaw, Clifton Choctaw, Jena Choctaw, Mississippi Choctaw, Mowa Band of Choctaw, Oklahoma Choctaw, Chumash, Santa Ynez, Clear Lake, Coeur D'Alene, Coharie, Colorado River, Colville, Comanche, Oklahoma Comanche, Coos, Lower Umpqua, Siuslaw, Coos, Coquilles, Costanoan, Coushatta, Alabama Coushatta, Cowlitz, Cree, Creek, Alabama Creek, Alabama Quassarte, Eastern Creek, Eastern Muscogee, Kialegee, Lower Muscogee, Machis Lower Creek Indian, Poarch Band, Principal Creek Indian Nation, Star Clan of Muscogee Creeks, Thlopthlocco, Tuckabachee, Croatan, Crow, Cupeno, Agua Caliente, Delaware, Eastern Delaware, Lenni-Lenape, Munsee, Oklahoma Delaware, Rampough Mountain, Sand Hill, Diegueno, Campo, Capitan Grande, Cuyapaipe, La Posta, Manzanita, Mesa Grande, San Pasqual, Santa Ysabel, Sycuan, Eastern Tribes, Attacapa, Biloxi, Georgetown, Moor, Nansemond, Natchez, Nausu Waiwash, Nipmuc, Paugussett, Pocomoke Acohonock, Southeastern Indians, Susquehanock, Tunica Biloxi, Waccamaw-Siousan, Wicomico, Esselen, Fort Belknap, Fort Berthold, Fort Mcdowell, Fort Hall, Gabrieleno, Grand Ronde, Gros Ventres, Atsina, Haliwa, Hidatsa, Hoopa, Trinity, Whilkut, Hoopa Extension, Houma, Inaja-Cosmit, Iowa, Iowa of Kansas-Nebraska, Iowa of Oklahoma, Iroquois, Cayuga, Mohawk, Oneida, Onondaga, Seneca, Seneca Nation, Seneca-Cayuga, Tonawanda Seneca, Tuscarora, Wyandotte, Juaneno, Kalispel, Karuk, Kaw, Kickapoo, Oklahoma Kickapoo, Texas Kickapoo, Kiowa, Oklahoma Kiowa, Klallam, Jamestown, Lower Elwha, Port Gamble Klallam, Klamath, Konkow, Kootenai, Lassik, Long Island, Matinecock, Montauk, Poospatuck, Setauket, Luiseno, La Jolla, Pala, Pauma, Pechanga, Soboba, Twenty-Nine Palms, Temecula, Lumbee, Lummi, Maidu, Mountain Maidu, Nishinam, Makah, Maliseet, Mandan, Mattaponi, Menominee, Miami, Illinois Miami, Indiana Miami, Oklahoma Miami, Miccosukee, Micmac, Aroostook, Mission Indians, Miwok, Modoc, Mohegan, Mono, Nanticoke, Narragansett, Navajo, Alamo Navajo, Canoncito Navajo, Ramah Navajo, Nez Perce, Nomalaki, Northwest Tribes, Alsea, Celilo, Columbia, Kalapuya, Molala, Talakamish, Tenino, Tillamook, Wenatchee, Yahooskin, Omaha, Oregon Athabaskan, Osage, Otoe-Missouria, Ottawa, Burt Lake Ottawa, Michigan Ottawa, Oklahoma Ottawa, Paiute, Bishop, Bridgeport, Burns Paiute, Cedarville, Fort Bidwell, Fort Independence, Kaibab, Las Vegas, Lone Pine, Lovelock, Malheur Paiute, Moapa, Northern Paiute, Owens Valley, Pyramid Lake, San Juan Southern Paiute, Southern Paiute, Summit Lake, Utu Utu Gwaitu Paiute, Walker River, Yerington Paiute, Pamunkey, Passamaquoddy, Indian Township, Pleasant Point Passamaquoddy, Pawnee, Oklahoma Pawnee, Penobscot, Peoria, Oklahoma Peoria, Pequot, Marshantucket Pequot, Pima, Gila River Pima-Maricopa, Salt River Pima-Maricopa, Piscataway, Pit River, Pomo, Central Pomo, Dry Creek, Eastern Pomo, Kashia, Northern Pomo, Scotts Valley, Stonyford, Sulphur Bank, Ponca, Nebraska Ponca, Oklahoma Ponca, Potawatomi, Citizen Band Potawatomi, Forest County, Hannahville, Huron Potawatomi, Pokagon Potawatomi, Prairie Band, Wisconsin Potawatomi, Powhatan, Pueblo, Acoma, Arizona Tewa, Cochiti, Hopi, Isleta, Jemez, Keres, Laguna, Nambe, Picuris, Piro, Pojoaque, San Felipe, San Ildefonso, San Juan Pueblo, San Juan De, San Juan, Sandia, Santa Ana, Santa Clara, Santo Domingo, Taos, Tesuque, Tewa, Tigua, Zia, Zuni, Puget Sound Salish, Duwamish, Kikiallus, Lower Skagit, Muckleshoot, Nisqually, Nooksack, Port Madison, Puyallup, Samish, Sauk-Suiattle, Skokomish, Skykomish, Snohomish, Snoqualmie, Squaxin Island, Steilacoom, Stillaguamish, Suquamish, Swinomish, Tulalip, Upper Skagit, Quapaw, Quinault, Rappahannock, Reno-Sparks, Round Valley, Sac and Fox, Iowa Sac and Fox, Missouri Sac and Fox, Oklahoma Sac and Fox, Salinan, Salish, Salish and Kootenai, Schaghticoke, Scott Valley, Seminole, Big Cypress, Brighton, Florida Seminole, Hollywood Seminole, Oklahoma Seminole, Serrano, San Manual, Shasta, Shawnee, Absentee Shawnee, Eastern Shawnee, Shinnecock, Shoalwater Bay, Shoshone, Battle Mountain, Duckwater, Elko, Ely, Goshute, Panamint, Ruby Valley, Skull Valley, South Fork Shoshone, Te-Moak Western Shoshone, Timbi-Sha Shoshone, Washakie, Wind River Shoshone, Yomba, Shoshone Paiute, Duck Valley, Fallon, Fort McDermitt, Siletz, Sioux, Blackfoot Sioux, Brule Sioux, Cheyenne River Sioux, Crow Creek Sioux, Dakota Sioux, Flandreau Santee, Fort Peck, Lake Traverse Sioux, Lower Brule Sioux, Lower Sioux, Mdewakanton Sioux, Miniconjou, Oglala Sioux, Pine Ridge Sioux, Pipestone Sioux, Prairie Island Sioux, Prior Lake Sioux, Rosebud Sioux, Sans Arc Sioux, Santee Sioux, Sisseton-Wahpeton, Sisseton Sioux, Spirit Lake Sioux, Standing Rock Sioux, Teton Sioux, Two Kettle Sioux, Upper Sioux, Wahpekute Sioux, Wahpeton Sioux, Wazhaza Sioux, Yankton Sioux, Yanktonai Sioux, Siuslaw, Spokane, Stewart, Stockbridge, Susanville, Tohono O'Odham, Ak-Chin, Gila Bend, San Xavier, Sells, Tolowa, Tonkawa, Tygh, Umatilla, Umpqua, Cow Creek Umpqua, Ute, Allen Canyon, Uintah Ute, Ute Mountain Ute, Wailaki, Walla-Walla, Wampanoag, Gay Head Wampanoag, Mashpee Wampanoag, Warm Springs, Wascopum, Washoe, Alpine, Carson, Dresslerville, Wichita, Wind River, Winnebago, Ho-chunk, Nebraska Winnebago, Winnemucca, Wintun, Wiyot, Table Bluff, Yakama, Yakama Cowlitz, Yaqui, Barrio Libre, Pascua Yaqui, Yavapai Apache, Yokuts, Chukchansi, Tachi, Tule River, Yuchi, Yuman, Cocopah, Havasupai, Hualapai, Maricopa, Mohave, Quechan, Yavapai, Yurok, Coast Yurok, Alaska Native, Alaska Indian, Alaskan Athabascan, Ahtna, Alatna, Alexander, Allakaket, Alanvik, Anvik, Arctic, Beaver, Birch Creek, Cantwell, Chalkyitsik, Chickaloon, Chistochina, Chitina, Circle, Cook Inlet, Copper Center, Copper River, Dot Lake, Doyon, Eagle, Eklutna, Evansville, Fort Yukon, Gakona, Galena, Grayling, Gulkana, Healy Lake, Holy Cross, Hughes, Huslia, Iliamna, Kaltag, Kluti Kaah, Knik, Koyukuk, Lake Minchumina, Lime, Mcgrath, Manley Hot Springs, Mentasta Lake, Minto, Nenana, Nikolai, Ninilchik, Nondalton, Northway, Nulato, Pedro Bay, Rampart, Ruby, Salamatof, Seldovia, Slana, Shageluk, Stevens, Stony River, Takotna, Tanacross, Tanaina, Tanana, Tanana Chiefs, Tazlina, Telida, Tetlin, Tok, Tyonek, Venetie, Wiseman, Southeast Alaska, Tlingit-Haida, Angoon, Central Council of Tlingit and Haida Tribes, Chilkat, Chilkoot, Craig, Douglas, Haida, Hoonah, Hydaburg, Kake, Kasaan, Kenaitze, Ketchikan, Klawock, Pelican, Petersburg, Saxman, Sitka, Tenakee Springs, Tlingit, Wrangell, Yakutat, Tsimshian, Metlakatla, Eskimo, Greenland Eskimo, Inupiat Eskimo, Ambler, Anaktuvuk, Anaktuvuk Pass, Arctic Slope Inupiat, Arctic Slope Corporation, Atqasuk, Barrow, Bering Straits Inupiat, Brevig Mission, Buckland, Chinik, Council, Deering, Elim, Golovin, Inalik Diomede, Inupiaq, Kaktovik, Kawerak, Kiana, Kivalina, Kobuk, Kotzebue, Koyuk, Kwiguk, Mauneluk Inupiat, Nana Inupiat, Noatak, Nome, Noorvik, Nuiqsut, Point Hope, Point Lay, Selawik, Shaktoolik, Shishmaref, Shungnak, Solomon, Teller, Unalakleet, Wainwright, Wales, White Mountain, White Mountain Inupiat, Mary's Igloo, Siberian Eskimo, Gambell, Savoonga, Siberian Yupik, Yupik Eskimo, Akiachak, Akiak, Alakanuk, Aleknagik, Andreafsky, Aniak, Atmautluak, Bethel, Bill Moore's Slough, Bristol Bay Yupik, Calista Yupik, Chefornak, Chevak, Chuathbaluk, Clark's Point, Crooked Creek, Dillingham, Eek, Ekuk, Ekwok, Emmonak, Goodnews Bay, Hooper Bay, Iqurmuit (Russian Mission), Kalskag, Kasigluk, Kipnuk, Koliganek, Kongiganak, Kotlik, Kwethluk, Kwigillingok, Levelock, Lower Kalskag, Manokotak, Marshall, Mekoryuk, Mountain Village, Naknek, Napaumute, Napakiak, Napaskiak, Newhalen, New Stuyahok, Newtok, Nightmute, Nunapitchukv, Oscarville, Pilot Station, Pitkas Point, Platinum, Portage Creek, Quinhagak, Red Devil, St. Michael, Scammon Bay, Sheldon's Point, Sleetmute, Stebbins, Togiak, Toksook, Tulukskak, Tuntutuliak, Tununak, Twin Hills, Georgetown, St. Mary's, Umkumiate, Aleut, Alutiiq Aleut, Tatitlek, Ugashik, Bristol Bay Aleut, Chignik, Chignik Lake, Egegik, Igiugig, Ivanof Bay, King Salmon, Kokhanok, Perryville, Pilot Point, Port Heiden, Chugach Aleut, Chenega, Chugach Corporation, English Bay, Port Graham, Eyak, Koniag Aleut, Akhiok, Agdaagux, Karluk, Kodiak, Larsen Bay, Old Harbor, Ouzinkie, Port Lions, Sugpiaq, Suqpigaq, Unangan Aleut, Akutan, Aleut Corporation, Aleutian, Aleutian Islander, Atka, Belkofski, Chignik Lagoon, King Cove, False Pass, Nelson Lagoon, Nikolski, Pauloff Harbor, Qagan Toyagungin, Qawalangin, St. George, St. Paul, Sand Point, South Naknek, Unalaska, Unga, Asian, Asian Indian, Bangladeshi, Bhutanese, Burmese, Cambodian, Chinese, Taiwanese, Filipino, Hmong, Indonesian, Japanese, Korean, Laotian, Malaysian, Okinawan, Pakistani, Sri Lankan, Thai, Vietnamese, Iwo Jiman, Maldivian, Nepalese, Singaporean, Madagascar, Black or African American, Black, African American, African, Botswanan, Ethiopian, Liberian, Namibian, Nigerian, Zairean, Bahamian, Barbadian, Dominican, Dominica Islander, Haitian, Jamaican, Tobagoan, Trinidadian, West Indian, Native Hawaiian or Other Pacific Islander, Polynesian, Native Hawaiian, Samoan, Tahitian, Tongan, Tokelauan, Micronesian, Guamanian or Chamorro, Guamanian, Chamorro, Mariana Islander, Marshallese, Palauan, Carolinian, Kosraean, Pohnpeian, Saipanese, Kiribati, Chuukese, Yapese, Melanesian, Fijian, Papua New Guinean, Solomon Islander, New Hebrides, White, European, Armenian, English, French, German, Irish, Italian, Polish, Scottish, Middle Eastern or North African, Assyrian, Egyptian, Iranian, Iraqi, Lebanese, Palestinian, Syrian, Afghanistani, Israeili, Arab, Other Race, Other Pacific Islander

Ethnicity:

Hispanic or Latino, Spaniard, Andalusian, Asturian, Castillian, Catalonian, Belearic Islander, Gallego, Valencian, Canarian, Spanish Basque, Mexican, Mexican American, Mexicano, Chicano, La Raza, Mexican American Indian, Central American, Costa Rican, Guatemalan, Honduran, Nicaraguan, Panamanian, Salvadoran, Central American Indian, Canal Zone, South American, Argentinean, Bolivian, Chilean, Colombian, Ecuadorian, Paraguayan, Peruvian, Uruguayan, Venezuelan, South American Indian, Criollo, Latin American, Puerto Rican, Cuban, Dominican, Not Hispanic or Latino

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