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Wednesday, October 5, 2011

MeaningfulUse Stage 2 Certification Spreadsheet

Last week the HIT Standards Committee finished up its "Summer Camp".  One of the last items discussed was a spreadsheet of proposed "Certification Critieria" that the Implementation Workgroup had been developing.  Most of the material provided over Summer Camp has been discussed in several HITSC meetings, but this one was previewed for the first time last week.

This is still clearly work in development, and will likely be reviewed again on the next HITSC call.  I've done three things with the PDF presented by the team:

  1. Turned it into a Word Document you can access here.
  2. Turned it into an Excel Spreadsheet you can access here.
  3. Summarized (without editorializing -- because I'm still digesting) the changes below.
My summary for each of the rows in the spreadsheet appears below:

1. CPOE: Increase CPOE for Medications to 60%
    Ensure that 60% Patients with Lab Results have at least one lab order
    and that at least 1 radiology test is ordered
2.  Drug/Drug/Allergy Interactions: Clarifies the "ability of certain users to adjust notifications" to mean adjust severity level, and to restrict capability to certain users.
3.  eRX: EPs to increase number of eRX to 50%, and EHs to transmit 10% of discharge med orders electronically.  Support NCPDP SCRIPT 10.7, and use HL7 V2 within walls of same organization.
4.  Demographics: Raised threshold to 80%, added ISO 639-1 for language
5.  Problems: Added ICD-10-CM 
10. Clinical Decision Support: Implement rules based on clinical data, enable configuration based on user role, workflow, patient context, and display source/evidence for rule to end user
11. Drug Formulary check: Move to core
12. Clinical Quality measures:  Depends on quality measures selected.  Some discussion on maintaining PQRI or using QRDA.
13. Advance Directives: Move to Core, increase to 50% for EHs, add requirement for EPs to note existence for at least 25 patients.  In addition to recording existence, store and provide access to copy of directive.
15. Lab Results: Hospital labs to send directly or indirectly results for more than 40% of orders recieved.  No standard identified, but noted to be needed.
16. Patient Lists: Move to core
17. Patient Reminders: Reminders sent to more than 10% of "Active Patients" (e.g., all seen in last 24 months)
18. Electronic Notes: EPs enter at least one electronic note (non-scanned, but can be electronic text w/o structure) for more than 30% of unique visits, EHs similar requirement, but one note for more thant 30% OF eligible "hospital days".  Questions raised for ED providers regarding definitions.
19. eMAR: EH only, Med orders tracked via EMAR in at least one ward/hospital 
unit.
23. View and Download: More than 10% of patients have ability to view and download information or have information transmitted to them, including summaries, discharges, and instructions (combining three previous critiera).  
24. Clinical Summaries: Suggest to move to one standard from two currently (CCR and CCD).
25. Patient Specific Education Resources: Move to core.  Provide patient education for more than 10% of all unique patients (removed "if appropriate").
26. Secure Messaging: EPs: Patients are offered secure messaging and at least 25 use it.  No standards identified.
27. Patient communication medium preference: EPs Record patient preferences for communciation for more than 20% of all patients.  Comments on lack of standard describing communication medium.
29. Exchanging Information: Move to core.  EPs and EHs: Record and send by paper or electronically a summary of care record for more than 50% of transitions of care for the referring EP or EH.  Record care plans and care team members for more than 10% of patients seend during reporting period. 
EH: Electronically exchange summary for at least 10% of discharges.  EP: Electronically exchange summary for at least 25 patients undergoing a transition of care.  Suggest to move to one standard from two currently (CCR and CCD).
30. Medication Reconciliation: Move to Core.
31. Immunization registries:  Move to core.  Attest to at least one submission. Suggestion to Split requirements into a) electronically record, and b) electronically submit.
32. Reportable Lab Results: Move to core. Attest to at least one submission. Suggestion to Split requirements into a) electronically record, and b) electronically submit.
33. Syndromic Surveillance: Move to core. Attest to at least one submission. Suggestion to Split requirements into a) electronically record, and b) electronically submit.  Possibly support IHE Cancer Registry reporting, but notes it requires adoption of CDA by Public Health who is struggling with HL7 2.5.1.
37. Audit Log: Added tamper resistance: Actions recorded in read only format, detect alteration of logs.
38. Security: Suggested replacing SHA-1 with SHA-2
43.-51. Privacy and Security.  New HITPC suggested requirements but little or no HITSC guidance.
52. Amendments: Ability to amend information and document disputed information.
53: Patient Matching: New HITPC suggested requirements but little or no HITSC guidance.  References guidance from Patient Matching Power team.


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