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Tuesday, April 10, 2012

Writing to and Reading From /dev/nul in MeaningfulUse Stage2


John Moehrke brings up an excellent point in his post on Meaningful Transmissions into Oblivion.

There is an assumption in Meaningful Use that a Certified EHR will both send and receive summary of care records formatted according to the standard at 170.205(a)(3), transported using the standards at 170.202.  But this is never spelled out in detail.
§170.314(b)(1) Transitions of care—incorporate summary care record. Upon receipt of a summary care record formatted according to the standard adopted at...
Two words:  Upon receipt.  But where in the rule does it ever say that an EHR must be able to receive such a thing?  There's a whole section on "View, Download and Transmit" under patient engagement.  There are discussions about being able to create clinical summaries in the correct format to give to the patient , or to Create and transmit a summary care record (in §170.314(b)(2) immediately following the above).  But nowhere in the rule is the term "Recieve" used in the context of "receive of summary of care record" using any of the standards specified.  And don't even get me started on the clarity in 170.202 and the various places that it is used.

With no receive requirement, we are effectively writing to /dev/nul


Now, I'll bring up another problem that is caused by something  missing from the rule.

Today, providers are expected to create either a CCR or a CCD (using HITSP C32) to provide a summary of care record.  In the future they will need to create a Consolidated CDA document of some sort.  What happens to the provider who is using a 2014 Certified EHR but still needs to be able to access CCD/CCR documents from his trading partners that are either still generating CCD or CCR documents, or for which a historical CCR/CCD document is available.  There's no "backwards compatibility".  At the very least, a Stage 2 certified EHR should be able to view a CCD or CCR that was created under the prior certification criteria.  After all, it is just a stylesheet transformation.

Without that requirement, we are effectively trying to access patient history by reading from /dev/nul

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