Convert your FHIR JSON -> XML and back here. The CDA Book is sometimes listed for Kindle here and it is also SHIPPING from Amazon! See here for Errata.

Tuesday, February 28, 2012

MeaningfulUse Certification Criteria Crosswalk to Standards


This is the second of two tables from the Meaningful Use Standards rule that I've prepared.  The first table mapped the objectives to the criteria.

This table crosswalks from the old Stage 1 criteria to the Stage 2 criteria and the standards in Stage 2.  The notes column combines information from several tables to tell you whether the criterion is Ambulatory or Inpatient (A or I), included in the definition of a Base EHR (B), requires clock synchronization using NTP (C), or must be implemented with User Centered design (U).  New criteria are shown in bold.  As before, when the regulation is published in the Federal Register, I'll link citations back to it on the Web, and when I get around to it, I'll add web links to the standards (until then, you can find most of the links you need here).

If you want the spreadsheet containing both of these tables, it's here.  Feel free to use these pages or the spreadsheets for developing your own comments and in presentations (please cite your source).

Stage 1 Meaningful Use Stage 2 Cross Walk
Amb. Inpatient Stage 2 Notes Certification  Criteria Standards
304(a) 306(a) 314(a)(1) BU Computerized provider order entry
302(a) 314(a)(2) BCU Drug-drug, drug-allergy interaction checks
304(c) 306(b) 314(a)(3) B Demographics 207(f) OMB standards for the classification of federal data on race and ethnicity
207(j) ISO 639-1:2002 (preferred language)
207(k) ICD-10-CM (preliminary cause of death)
302(f) 314(a)(4) B Vital signs, body mass index, and growth charts
302(c) 314(a)(5) B Problem list 207(a)(3) SNOMED-CT® International Release January 2012
302(d) 314(a)(6) BU Medication list
302(e) 314(a)(7) BU Medication allergy list
304(e) 306(c) 314(a)(8) BCU Clinical decision support 204(b)(1) HL7 Context-Aware Knowledge Retrieval (Infobutton) Standard, International Normative
Edition 2010
314(a)(9) Clinical Notes
302(b) 314(a)(10) C Drug-formulary checks
302(g) 314(a)(11) Smoking status 207(l) smoking status types
314(a)(12) Imaging
314(a)(13) Family History
302(i) 314(a)(14) C Patient lists
304(d) 314(a)(15) A Patient reminders
302(m) 314(a)(16) Patient-specific education resources 204(b)(1)  HL7 Context-Aware Knowledge Retrieval (Infobutton) Standard, International Normative
Edition 2010
314(a)(17) CIU Medication Administration: Five Rights 210(g) Synchronized clocks
306(h) 314(a)(18) I Advance directives
304(i) 306(f) 314(b)(1)
314(b)(2)
B Transitions of care – incorporate/create summary care record 205(a)(3) Consolidated CDA
207(f) OMB standards for the classification of federal data on race and ethnicity
207(j) ISO 639-1:2002 (preferred language)
207(l) smoking status types
207(a)(3) SNOMED-CT® International Release January 2012
207(m) ICD-10-CM
207(b)(2) HCPCS and CPT-4
207(b)(3) ICD-10-PCS
207(g) LOINC version 2.38
207(h) RxNorm February 6, 2012 Release
314(b)(2) Transitions of care – transmit summary care record 202(a)(1) Applicability Statement for Secure Health Transport
202(a)(2) XDR and XDM for Direct Messaging
202(a)(3) SOAP-Based Secure Transport RTM version 1.0 (Optional)
304(b) 314(b)(3) U Electronic prescribing 205(b)(2) NCPDP SCRIPT version 10.6
207(h) RxNorm February 6, 2012 Release
302(j) 314(b)(4) U Clinical information reconciliation
302(h) 314(b)(5) A Incorporate lab tests and values/results 205(k)  HL7 2.5.1 and HL7 Version 2.5.1 Implementation Guide: Standards and Interoperability Framework Lab Results Interface, Release 1 (US Realm)
207(g)  LOINC version 2.38
§493.1291(c)(1-7) CLIA
314(b)(6) I Transmit Lab Results 205(k)  HL7 2.5.1 and HL7 Version 2.5.1 Implementation Guide: Standards and Interoperability Framework Lab Results Interface, Release 1 (US Realm)
207(g)  LOINC version 2.38
314(c)(1) B Clinical Quality Measures - Capture and Export 204(c) National Quality Forum (NQF) Quality Data Model (QDM)
314(c)(2) B Clinical quality measures – incorporate and calculate
314(c)(3) Clinical quality measures – reporting "a data file defined by CMS"
302(o) 314(d)(1) B Authentication, access control, and authorization
302(t)
314(d)(2) B Auditable events and tamper-resistance
302(r) 314(d)(3) B Audit report(s)
314(d)(4) B Amendments
302(q) 314(d)(5) B Automatic log-off
302(p) 314(d)(6) B Emergency access
302(u) 314(d)(7) B Encryption of data at rest 210(a)(1) FIPS 140-2 Annex A for Encryption and Hashing
302(s) 314(d)(8) B Integrity 210(c)  FIPS PUB 180–3 (SHA-1)
302(w) 314(d)(9) Accounting of disclosures (optional) 210(d) date, time, patient identification, user
identification, and a description of the
disclosure 
304(g) 314(e)(1) B View, download, and transmit to 3rd party 204(a) Web Content Accessibility Guidelines (WCAG) 2.0, Level AA Conformance 
304(f) 306(d) 205(a)(3) Consolidated CDA
306(e) 205(j) DICOM PS 3—2011
207(f) OMB standards for the classification of federal data on race and ethnicity
207(j) ISO 639-1:2002 (preferred language)
207(l) smoking status types
207(a)(3) SNOMED-CT® International Release January 2012
207(m) ICD-10-CM
207(b)(2) HCPCS and CPT-4
207(b)(3) ICD-10-PCS
207(g) LOINC version 2.38
207(h) RxNorm February 6, 2012 Release
202(a)(1) Applicability Statement for Secure Health Transport
202(a)(2) XDR and XDM for Direct Messaging
210(g) Synchronized clocks
304(h) 314(e)(2) A Clinical Summaries
314(e)(3) A Secure Messaging 210(f) FIPS 140-2 Annex A for Encryption and Hashing
302(k) 314(f)(1) Record, Change and access Immunization information
314(f)(2) C Transmission to immunization registries 205(e)(3)  HL7 2.5.1 and Implementation Guide for Immunization Messaging Release 1.3
207(i)  CVX code set: August 15, 2011 version
302(l) 314(f)(3) Record, Change and access surveillance information
314(f)(4) C Transmission to PH agencies 205(d)(2)  HL7 2.5.1
205(d)(3)  HL7 2.5.1 and the PHIN Messaging Guide for Syndromic Surveillance: Emergency Department and Urgent Care Data HL7 Version 2.5.1
306(g) 314(f)(5) Reportable lab tests and values/results
314(f)(6) C Transmission of reportable lab tests and values/results 205(g)  HL7 2.5.1 and HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 (US Realm) with errata
207(a)(3)  SNOMED CT® International Release January 2012
207(g)  LOINC version 2.38
314(f)(7) Record, Change and Access Cancer Information
314(f)(8) C Transmission to Cancer Registries 205(i)  HL7 CDA, Release 2 and Implementation Guide for Healthcare Provider Reporting to Central Cancer Registries, Draft, February 2012
207(a)(3)  SNOMED CT® International Release January 2012
207(g)  LOINC version 2.38
314(g)(1) Automated numerator recording
302(n) 314(g)(2) Automated measure calculation
314(g)(3) Non-percentage-based measure use report 210(g) Synchronized clocks
314(g)(4) Safety-enhanced design

MeaningfulUse Objectives Mapped to the ONC Certification Criteria

This table maps the Meaningful Use objectives and measures for Stage 2 to the Certification Criteria.  When the rules get published, I'll add links from citations to the Federal Register pages.  See my next post for another great table mapping certification criteria to standards (and for the spreadsheet link).

 Stage 2 Objectives  
Citation  Eligible Professionals   Citation  Eligible Hospitals and CAHs    Stage 2 Measures  Certification Criteria
 CORE SET  
 Improving quality, safety, efficiency, and reducing health disparities  
§495.6 (j)(1)  Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per State, local and professional guidelines to create the first record of the order.   §495.6 (l)(1)  Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per State, local and professional guidelines to create the first record of the order.    More than 60 percent of medication, laboratory, and radiology orders created by the EP or authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using CPOE.   § 170.314(a)(1)
§495.6 (j)(2)  Generate and transmit permissible prescriptions electronically (eRx)    More than 65 percent of all permissible prescriptions written by the EP are compared to at least one drug formulary and transmitted electronically using Certified EHR Technology.   § 170.314(a)(10)
§495.6 (j)(3)  Record the following demographics
• Preferred language
• Gender
• Race
• Ethnicity
• Date of birth
 
§495.6 (l)(2)  Record the following 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  
 More than 80 percent 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   § 170.314(a)(3)
§495.6 (j)(4)  Record and chart changes in vital signs:
• Height/length
• Weight
• Blood pressure (age 3 and over)
• Calculate and display BMI
• Plot and display growth charts for patients 0-20 years, including BMI
 
§495.6 (l)(3)  Record and chart changes in vital signs:
• Height/length
• Weight
• Blood pressure (age 3 and over)
• Calculate and display BMI
• Plot and display growth charts for patients 0-20 years, including BMI  
 More than 80 percent 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 blood pressure (for patients age 3 and over only) and height/length and weight (for all ages) recorded as structured data   § 170.314(a)(4)
§495.6 (j)(5) Record smoking status for patients 13 years old or older   §495.6 (l)(4) Record smoking status for patients 13 years old or older    More than 80% 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 § 170.314(a)(11)
§495.6 (j)(6) Use clinical decision support to improve performance on high-priority health conditions   §495.6 (l)(5) Use clinical decision support to improve performance on high-priority health conditions   1. Implement 5 clinical decision support interventions related to 5 or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period.
2. The EP, eligible hospital or CAH has enabled and implemented the functionality for drug-drug and drug allergy interaction checks for the entre EHR reporting period.
§ 170.314(a)(8)
§495.6 (j)(7) Incorporate clinical lab-test results into Certified EHR Technology as structured data §495.6 (l)(6) Incorporate clinical lab-test results into Certified EHR Technology as structured data More than 55 percent of all clinical lab tests results ordered by the EP or by authorized providers 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 either in a positive/negative or numerical format are incorporated in Certified EHR Technology as structured data § 170.314(b)(5)
§495.6 (j)(8) Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach  §495.6 (l)(7) Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach  Generate at least one report listing patients of the EP, eligible hospital or CAH with a specific condition.  § 170.314(a)(14)
§495.6 (j)(9) Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care  More than 10 percent of all unique patients who have had an office visit with the EP within the 24 months prior to the beginning of the EHR reporting period were sent a reminder, per patient preference  § 170.314(a)(15)
§495.6 (l)(16) Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR)  More than 10 percent of medication orders created by authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period are tracked using eMAR..  § 170.314(a)(17)
Engage patients and families in their health care
§495.6 (j)(10) Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP. 1. More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available
to the EP) online access to their health information subject to the EP's discretion to withhold certain information
2. More than 10 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download , or transmit to a third party their health information
§ 170.314(e)(1)
§495.6 (l)(8) Provide patients the ability to view online, download, and transmit information about a hospital admission 1. More than 50 percent of all patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH have their information available online within 36 hours of discharge
2. More than 10 percent of all patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH view, download or transmit to a third party their information during the reporting period
§ 170.314(e)(1)
§495.6 (j)(11) Provide clinical summaries for patients for each office visit Clinical summaries provided to patients within 24 hours for more than 50 percent of office visits. § 170.314(e)(2)
§495.6 (j)(12) Use Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient §495.6 (l)(9) Use Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient Patient-specific education resources identified by Certified EHR Technology are provided to patients for more than 10 percent of all office visits by the EP. More than 10 percent of all unique patients admitted to the eligible hospital's or CAH's inpatient or emergency departments (POS 21 or 23) are provided patient- specific education resources identified by Certified EHR Technology § 170.314(a)(16)
§495.6 (j)(17) Use secure electronic messaging to communicate with patients on relevant health information  A secure message was sent using the electronic messaging function of Certified EHR Technology by more than 10 percent of unique patients seen during the EHR reporting period  § 170.314(e)(3)
Improve care coordination 
§495.6 (j)(13) The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.  §495.6 (l)(10) The 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  The EP, eligible hospital or CAH performs medication reconciliation for more than 65 percent 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).  § 170.314(b)(4)
§495.6 (j)(14) The EP 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 care record for each transition of care or referral.  §495.6 (l)(11) The 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 care record for each transition of care or referral.  1. The EP, eligible hospital, or CAH that transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 65 percent of transitions of care and referrals.
2. The EP, eligible hospital, or CAH that transitions or refers their patient to another setting of care or provider of care electronically transmits a summary of care record using certified EHR technology to a recipient with no organizational affiliation and using a different Certified EHR Technology vendor than the sender for more than 10 
§ 170.314(b)(1)
§ 170.314(b)(2)
Improve population and public health 
§495.6 (j)(15) Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice  §495.6 (l)(12) Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice  Successful ongoing submission of electronic immunization data from Certified EHR Technology to an immunization registry or immunization information system for the entire EHR reporting period  § 170.314(f)(1)
§ 170.314(f)(2)
§495.6 (l)(13) Capability to submit electronic reportable laboratory results to public health agencies, except where prohibited, and in accordance with applicable law and practice  Successful ongoing submission of electronic reportable laboratory results from Certified EHR Technology to public health agencies for the entire EHR reporting period as authorized.  § 170.314(f)(5)
§ 170.314(f)(6)
§495.6 (l)(14) Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice  Successful ongoing submission of electronic syndromic surveillance data from Certified EHR Technology to a public health agency for the entire EHR reporting period  § 170.314(f)(3)
§ 170.314(f)(4)
Ensure adequate privacy and security protections for personal health information
§495.6 (j)(16) Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities §495.6 (l)(15) Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1), including addressing the encryption/security of data at rest in accordance with requirements under 45 CFR 164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider's risk management process. § 170.314(d)(7)
 MENU SET  
Improving quality, safety, efficiency, and reducing health disparities
§495.6 (m)(1) Record whether a patient 65 years old or older has an advance directive More than 50 percent of all unique patients 65 years old or older admitted to the eligible hospital's or CAH's inpatient department (POS 21) during the EHR reporting period have an indication of an advance directive status recorded as structured data. § 170.314(a)(18)
§495.6 (k)(1) Imaging results and information are accessible through Certified EHR Technology. §495.6 (m)(2) Imaging results and information are accessible through Certified EHR Technology. More than 40 percent of all scans and tests whose result is an image 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 and 23) during the EHR reporting period are accessible through Certified EHR Technology § 170.314(a)(12)
§495.6 (k)(2) Record patient family health history as structured data §495.6 (m)(3) Record patient family health history as structured data More than 20 percent of all unique patients seen by the EP or admitted to the eligible hospital or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period have a structured data entry for one or more first-degree relatives § 170.314(a)(13)
§495.6 (m)(4) Generate and transmit permissible discharge prescriptions electronically (eRx)  More than 10 percent of hospital discharge medication orders for permissible prescriptions (for new or changed prescriptions) are compared to at least one drug formulary and transmitted electronically using Certified EHR Technology  § 170.314(b)(3)
§ 170.314(a)(10)
§495.6 (k)(3) Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice  Successful ongoing submission of electronic syndromic surveillance data from Certified EHR Technology to a public health agency for the entire EHR reporting period  § 170.314(f)(3)
§ 170.314(f)(4)
§495.6 (k)(4) Capability to identify and report cancer cases to a State cancer registry, except where prohibited, and in accordance with applicable law and practice.  Successful ongoing submission of cancer case information from Certified EHR Technology to a cancer registry for the entire EHR reporting period  § 170.314(f)(7)
§ 170.314(f)(8)
§495.6 (k)(5) Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice.  Successful ongoing submission of specific case information from Certified EHR Technology to a specialized registry for the entire EHR reporting period 


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-- Keith

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HL7 Project Supports the U.S. Office of Personnel Management's BlueButton ® Requirements

I'm co-leading this project with Lenel James (whom I incorrectly reported as John Ritter earlier) in HL7.  Essentially, it's a stylesheet that creates a text rendering of a CCD document in the Blue Button format.  Corey Spears has already done a great deal of work on the stylesheet.  The stylesheet will be made available as freely down-loadable software to HL7 members.

  -- Keith

P.S. I'll be back to reviewing Meaningful Use shortly...



Contact:
Andrea Ribick
+1 (734) 677-7777


For Immediate Release                

Health Level Seven International Project Supports the U.S. Office of Personnel Management’s Blue Button® Requirements

Ann Arbor, Michigan February 28, 2012 – Health Level Seven® (HL7®) International, the global authority on standards for interoperability of health information technology with members in 55 countries, today announced a response to the U.S. Office of Personnel Management’s (OPM) recent requirement that U.S. Federal Employees Health Benefit Program (FEHBP) health insurance carriers support the U.S. Department of Veterans Affairs (VA) Blue Button® text file format as a means of conveying personal health information to federal employees. In January 2012, HL7 launched a project that defines the conversion of an HL7 Continuity of Care Document (CCD®) to the Blue Button format via an XSLT style sheet tool. Because most Meaningful Use–certified health information exchange systems already possess CCD-export capabilities, the tool will be able to leverage those capabilities as a simple and effective way for many carriers to meet OPM’s new requirement.

The Blue Button, developed by the VA in collaboration with the Centers for Medicare and Medicaid Services (CMS), empowers Veterans to access and download their health information as an ASCII text file or PDF® document. The Blue Button initiative was made nationally available in October 2010. In December 2011, OPM issued a formal request to all carriers in the FEHBP to add Blue Button functionality to their web-based personal health record systems. (See: http://www1.opm.gov/news/blue-button-added-to-health-insurance-carriers-for-federal-employees,1744.aspx )

The Blue Button service participates in the health information exchange continuum by enabling Veterans and consumers to share their data with clinicians and other caregivers via a simple text file. The service is part of the expanding landscape of national and local initiatives such as the Office of the National Coordinator’s Standards and Interoperability Framework and the Beacon Community Programs.

John Ritter, co-chair of the HL7 Electronic Health Record Work Group (EHR WG), noted that HL7 quickly assembled a broad set of industry stakeholders, including vendors, providers, payers, and federal agencies, as part of its ongoing commitment to be responsive to the industry’s needs in a timely manner.

The EHR WG and Structured Documents Work Group, co-sponsors of the project, expect to offer the file conversion tool and User’s Guide in April 2012. Doug Dormer, President of SPINNphr and member of the project team stated, “I am pleased to be involved in this project. This tool will reduce my technical team’s effort to offer a data download channel to consumers in the Blue Button format and help our clients meet OPM’s requirement.”

For more information visit: www.HL7.org/EHR


About HL7
Founded in 1987, Health Level Seven International is the global authority for healthcare information interoperability and standards with affiliates established in more than 30 countries. HL7 is a non-profit, ANSI accredited standards development organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services. HL7’s more than 2,300 members represent approximately 500 corporate members, which include more than 90 percent of the information systems vendors serving healthcare. HL7 collaborates with other standards developers and provider, payer, philanthropic and government agencies at the highest levels to ensure the development of comprehensive and reliable standards and successful interoperability efforts.

HL7’s endeavors are sponsored, in part, by the support of its benefactors: Abbott; Accenture; Allscripts; Booz Allen Hamilton; Centers for Disease Control and Prevention; Duke Translational Medicine Institute; Epic; European Medicines Agency; the Food and Drug Administration; GE Healthcare Information Technologies; GlaxoSmithKline; Hospital Corporation American (HCA); IBM; InterSystems Corporation; Kaiser Permanente; Lockheed Martin; McKesson Provider Technology; Microsoft Corporation; NICTIZ National Healthcare; Novartis; Oracle Corporation; Partners HealthCare System, Inc.; Pfizer, Inc.; Philips Healthcare; Quest Diagnostics Inc.; Siemens Healthcare; Thomson Reuters; the U.S. Department of Defense, Military Health System; and the U.S. Department of Veterans Affairs. For more information, please visit: www.HL7.org



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