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Thursday, September 11, 2014

ONC 2014 Edition Release 2

ONC figured out that it had a versioning problem with it's third release of the Certification and Standards rule.  This one (original entitled the 2015 edition) has been renamed to the 2014 Edition, Release 2.

What's new?  Not a lot actually.  As originally envisioned, there were plenty of changes coming to EHR vendors and users.  As written, it's a much smaller list of changes for everyone, which I summarize below.  A lot of what I complained about in the proposed rule is gone from the final rule. Other issues have simply been put off until stage 3 and 2017. In their own words ONC has "not adopted the Proposed Voluntary Edition. Rather, we have only  adopted a small subset of the proposed certification criteria as optional 2014 Edition EHR certification criteria and made revisions to 2014 Edition EHR certification criteria that provide flexibility, clarity, and enhance health information exchange."

  • Split CPOE into separate criteria for ordering Medications, labs and imaging.
  • Decoupled content and transport capabilities for transitions of care
  • Shifting the “incorporation” into an updated “clinical information reconciliation and incorporation” (CIRI) criterion.
  • Adopted Version 1.1 of Direct Edge Protocols
  • Decoupled the transport and content capabilities of the VDT certification criterion.
  • Allowed "any method or standard" to be used to "electronically create syndrome-based public health surveillance information for electronic transmission" for ambulatory use.  The net effect here is to enable meaningful users to claim the capability for the purpose of incentives if they electronically transmit surveillance data to public health.
  • Included an optional set of data elements (patient demographics, provider specialty, provider address, problem list, vital signs, laboratory results, procedures, medications, and insurance) to support surveillance.  This optional list on an optional criteria, basically serves the purpose of telling people the eventual direction they might go in a couple of years.
  • Discontinued use of the Complete EHR concept and Complete EHR certification
  • Created an ONC Certification Mark
There you have it, an even shorter summary of the short list of what ONC has added to certification in 2014.

I forgot to include Table 3 from the rule, which lists the differences between the various editions. It is quite useful
Table 3. Gap Certification Eligibility for 2014 Edition, Release 2 EHR Certification Criteria

2014 Edition Release 2
2014 Edition

2011 Edition

Regulation Section
Title of Regulation Paragraph
Regulation Section
Title of Regulation Paragraph
Regulation Section
Title of Regulation Paragraph
314(a)(18)
Optional – computerized physician order entry -medications
314(a)(1)

Computerized
physician order
entry

304(a)
306(a)

Computerized physician
order entry

314(a)(19)

Optional –
computerized
physician order
entry - laboratory

314(a)(20)

Optional –
computerized
physician order
entry – diagnostic
imaging

314(f)(7)*
Optional – ambulatory setting only – transmission to public health agencies – syndromic surveillance
 314(f)(3)
Transmission to public health agencies— syndromic surveillance (ambulatory setting only)
302(1)
Public health surveillance (ambulatory setting only)
314(h)(1)
Optional – Applicability Statement for Secure Health 
314(b)(1)(i)(A) and 314(b)(2)(ii)(A)
Transitions of care—receive, display, and incorporate transition of
care/referral summaries. Transitions of care—create and transmit
transition of care/referral summaries.
N/A
N/A
314(h)(2)
Optional – Applicability Statement for Secure Health Transport and XDR/XDM for Direct
Messaging
314(b)(1)(i)(B) and 314(b)(2)(ii)(B)
Transitions of care—receive, display, and incorporate transition of care/referral summaries. Transitions of care—create and transmit transition of  care/referral summaries.
N/A
N/A
314(h)(3)
Optional –SOAP Transport and   Security Specification and XDR/XDM for Direct Messaging
314(b)(1)(i)(C) and 314(b)(2)(ii)(C)
Transitions of care—create and transmit transition of care/referral summaries.
N/A
N/A
* Gap certification does not apply for the optional data elements listed in 314(f)(7).



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