ehr onc final certification - Department of Health Care Services

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meaningful use Stage 1 objectives. The Department noted that some commenters reported that having this information available would allow eligible hospitals to make decisions that were better aligned with the patient’s express wishes. The “record advance directives” certification criterion would ensure that Certified EHR Technology enables users to electronically record whether a patient has an advance directive, which in turn will help ensure that a patient’s wishes are known and can be followed. Meaningful Use Stage 1 Objective Record advance directives for patients 65 years old or older Meaningful Use Stage 1 Measure More than 50% of all unique patients 65 years old or older admitted to the eligible hospital’s or CAH’s inpatient department (POS 21) have an indication of an advance directive status recorded Page 178 of 228 Certification Criterion Final Rule Text: §170.306(h) Advance directives. Enable a user to electronically record whether a patient has an advance directive. Comments. The Department received several comments that we should include the capability to record advance directives as part of meaningful use of Certified EHR Technology and, specifically, that it should be a requirement that pertains to eligible hospitals. Other commenters reported that having this information available for the patient would allow eligible hospitals to make decisions that were better aligned with the patient’s express wishes. The HIT Policy Committee clarified that the purpose of the meaningful use Stage 1 measure would be to indicate whether a patient has an advanced directive. Furthermore, the committee recommended limiting this measure to patients 65 and older. Response. We agree that the capability for a Complete EHR or EHR Module designed for an inpatient setting should be included as a condition of certification. Including this certification criterion in this final rule will enable eligible hospitals to meet
a meaningful use objective they would otherwise not have been able to meet. We do not believe that the capability we have required will be a significant burden for Complete EHR and EHR Module developers and assume that some already have this or a similar type of capability already built in. Patient-Specific Education Resources The Medicare and Medicaid EHR Incentive Programs proposed rule discussed but did not include the objective of providing “access to patient specific education resources upon request,” primarily because of the belief that there was a paucity of knowledge resources integrated within EHRs that are also widely available. CMS also noted that the ability to provide patient education resources in multiple languages might be limited. In response to comments, the Medicare and Medicaid EHR Incentive Programs final rule included this objective and a related measure, finding that the availability of education resources linked to EHRs is in fact more widely available than the Department had previously indicated in the proposed rule. The Medicare and Medicaid EHR Incentive Programs final rule expressly requires that more than 10 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) during the EHR reporting period must be provided patient- specific education resources in order to meet the related meaningful use stage 1 objective. To support the achievement of this objective and measure, we are therefore adopting as a certification criterion the capability of enabling a user to electronically identify and provide patient-specific education resources that include particular types of data elements. Meaningful Use Stage 1 Objective Meaningful Use Stage 1 Measure Certification Criterion Page 179 of 228
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DEPARTMENT OF HEALTH AND HUMAN SERV
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HHS Department of Health and Human
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5. Definition of Qualified EHR 6. D
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technology. Section 3004(b)(1) of t
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esolve identified technical challen
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Some commenters appear to have misi
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efficiencies and desired quality im
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codes must be used “inside” an
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not necessarily have applied to our
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3. Definition of Implementation Spe
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program established by the National
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criteria adopted by the Secretary a
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Comment. In the context of the defi
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y the certification criteria for a
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commenters asked whether we meant t
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adopted by the Secretary. The secon
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Response. We would like to make cle
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Response. In the Interim Final Rule
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could be a health care professional
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standard for certain purposes. In s
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e voluntary and would not be requir
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already existing regulatory require
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setting). We also include, where ap
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clarification on why the number of
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more clearly specify this capabilit
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Response. While we do not require t
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that check, the functionality show
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Response. The comments are correct
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enable the user to electronically r
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longitudinal care, or whether the E
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EHR and EHR Module developers to pr
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suggestions for different age range
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Record smoking status for patients
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23) during the EHR reporting period
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laboratory test results are receive
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commenters reasoned that because a
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laboratory test results to be elect
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or outreach Generate patient lists.
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months). We believe that these revi
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that the PQRI 2009 Registry XML spe
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To better align this certification
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the capability specified by the cer
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vendors were unwilling or unable to
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the concerns expressed by some comm
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Page 89 of 228 electronically compa
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(1) The standard (and applicable im
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for the purposes of demonstrating c
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Guide for Immunization Messaging Re
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Response. We clarify for commenters
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serve as a limiting factor, however
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Page 101 of 228 Unchanged Comment.
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Comment. One commenter suggested th
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Response. We appreciate the thought
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Complete EHRs or EHR Modules design
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Response. We disagree. As stated ab
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Response. As discussed above, we ha
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SHA-1 and other secure hash algorit
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misinterpreted our example and stat
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Other commenters also expressed con
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eferenced in FIPS 140-2 Annex A, wh
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of the most secure encryption algor
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the disclosure was made (recipient)
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Use CPOE for medication orders dire
Page 127 and 128: equire EHRs to build custom interfa
Page 129 and 130: esult, we do not believe that this
Page 131 and 132: was needed before RxNorm could be a
Page 133 and 134: • MDDB - Medi-Span Master Drug Da
Page 135 and 136: Response. We do not believe that it
Page 137 and 138: Send reminders to patients per pati
Page 139 and 140: specified data elements and CMS’s
Page 141 and 142: what would qualify as a "response."
Page 143 and 144: Comment. A commenter recommended th
Page 145 and 146: in accordance with one of the adopt
Page 147 and 148: Comments. Many commenters suggested
Page 149 and 150: flexibility in this certification c
Page 151 and 152: productive, confusing, time-consumi
Page 153 and 154: include in this initial set. Accord
Page 155 and 156: to the HITSP C32 implementation spe
Page 157 and 158: Response. Again, we do not believe
Page 159 and 160: e achieved without these and recomm
Page 161 and 162: electronically record, store, retri
Page 163 and 164: EHRs and EHR Modules designed for a
Page 165 and 166: §170.205(a)(2)(iii); and (v) The s
Page 167 and 168: Response. We disagree, as doing so
Page 169 and 170: Dental Terminology as a condition o
Page 171 and 172: However, we do not preclude Complet
Page 173 and 174: ability of CCD and CCR to support t
Page 175 and 176: ability to receive these reports. M
Page 177: commenters acknowledged and express
Page 181 and 182: CMS and ONC had worked together to
Page 183 and 184: The eligible professional or eligib
Page 185 and 186: EHR technology with the needs of us
Page 187 and 188: The RFA requires agencies to analyz
Page 189 and 190: values seemed low and that the gap
Page 191 and 192: commenter provided), our assumption
Page 193 and 194: absolute low we estimated for a per
Page 195 and 196: number of previously CCHIT-certifie
Page 197 and 198: for Certification Low High Page 197
Page 199 and 200: Finally, the third type of cost we
Page 201 and 202: 2012 15% $10.10 $30.80 $20.45 3-Yea
Page 203 and 204: The RFA requires agencies to analyz
Page 205 and 206: The Office of Management and Budget
Page 207 and 208: The standards and implementation sp
Page 209 and 210: The Secretary adopts the following
Page 211 and 212: any edition other than that specifi
Page 213 and 214: (e) Regenstrief Institute, Inc., LO
Page 215 and 216: 4. Revise subpart C to read as foll
Page 217 and 218: smoker; current some day smoker; fo
Page 219 and 220: (2) Generate audit log. Enable a us
Page 221 and 222: (3) Medication allergy list; (4) De
Page 223 and 224: §170.205(a)(1) or §170.205(a)(2).
Page 225 and 226: (d) Electronic copy of health infor
Page 227 and 228: specifications) specified in §170.
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