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Friday, August 24, 2012

The bare essentials on changes in MeaningfulUse Stage2 Standards

8/28/2012: Corrected error on ICD-10-PCS. In the MU Common Data Set, this is listed as an Option, but SNOMED-CT and CPT-4/HCPCS appear to be a required capability.

Seven pages is TL;DR for most folks, so I've boiled it down to a single page of the bare essentials for Analysts, Managers and C-levels ;-)   If you haven't already looked at ONC's excellent resources, you might want to start there. If you want a detailed list of changes, look at last night's (really this morning's) post:

102 Definitions: Added the Common MU Data set. (See: There can be only one)

202 Transport: For exchange, you have three choices.  Direct is required in the certification criteria, but you can use it with XDM, or with XDR (over the Exchange SOAP Stack).  Just recall if you do XDR that you have to have a way to get to SMTP to succeed.  And you have to Send & Recieve now (see 314(b)(1) below).

204 Functional:  For the Patient Portal: They dropped back from  WCAG Level AA to Level A.  InfoButton: They added two implementation guides for InfoButton, and either may be used.  For certification, you can use other mechanisms in addition to InfoButton (e.g., to allow use of existing clinical content).

205 Content Reporting Quality Measures to CMS: HL7 QRDA Category I and III

207 Vocabulary
ICD-10: ICD-10-CM allowed for Encounter diagnosis, but so is SNOMED CT.  ICD-10-PCS is an option for proceduresw.
Procedures: SNOMED CT® or CPT/HCPCS required. ICD-10-PCS and dental codes are options.
Encounter Diagnosis:  ICD-10-CM is selected, but for certification, you can use SNOMED CT® or ICD-10-CM for the encounter.  I expect most will use SNOMED-CT.
Smoking Status: added SNOMED CT® codes and US Extension values, added Light/Heavy Smoker categories.
Family History use HL7 Clinical Genomics Pedigree or record using SNOMED CT.

314(a)(8) Clinical Decision Support: Clarified language about each one and a combination of the six data categories.  Basically, it seems to mean that you have to be able to enable interventional and referential CDS based on each category separately and individually, and a combination.

314(b)(1) View, Download and Transmit: Incorporate is just Problems, Meds and Allergies now.  Added Receive (see 202 above), and Display using Stage 1 standards, but Download and Transmit only need support Stage 2 (CCDA).

314(b)(7) Data Portability: Must support a batch export CCDA for all patients in the EMR.

314(c) Quality Measures: Read the detail, but basically: QRDA I and III, and import & export in addition to calculate.

Quality Management System and Price Transparency: This is well covered in the ONC Fact Sheet.

This mornings panic not-withstanding, overall, I'm quite pleased with
a) the end result,
b) the timeliness with which the regulation was produced
c) the responsiveness of ONC to feedback.

  -- Keith


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