ONC Releases Stage 2 EHR Criteria

The Office of the National Coordinator for Health IT released a proposed rule on EHR certification late Friday. The rule is a companion to the proposed rule on stage 2 of the meaningful use EHR incentive program released the preceding day by the Centers for Medicare and Medicaid Services. (Read the published certification rule here.)

ONC’s rule defines the technology standards and implementation specifications that will support the new and revised objectives and measures for stages 1 and 2 of the meaningful use program. Effective 2014, EHR technology must be certified against these criteria to be used in the program. The rule also proposes a change to the definition of a “qualified” EHR that would allow providers more flexibility in the scope of the systems they implement.

The rule is titled “Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology.” The Federal Register has filed it under the pithier name “Electronic Health Record Technology, 2014 Edition.”

Publication of the rule in the Federal Register is scheduled for March 7, coinciding with publication of the stage 2 proposed rule.

Classifications and Terminologies

ONC proposes the use of SNOMED CT for problems lists and clinical quality measures. The International Release January 2012 version would be required.

ICD-10-CM and –PCS would be used for encounter diagnoses and procedures.

However, with HHS’s recent announcement that it intends to delay ICD-10 implementation, ONC requests industry comment on whether it should be “more flexible” with the proposed requirement based on “any potential extension of the ICD-10 compliance deadline or possible delayed enforcement approach.”

Further, ONC asks whether it would be more appropriate to require EHR technology to be certified to a subset of ICD-10, either ICD-9 or ICD-10, or to both ICD-9 and ICD-10 for encounter diagnoses and procedures.

For procedures, ONC would continue to permit a choice for EHR technology certification, either ICD-10-PCS or the combination of HCPCS and CPT–4.

Preliminary cause of death would be reported using ICD-10-CM to take advantage of the increased specificity the code set provides.

LOINC 2.38 would be required laboratory tests, and RxNorm would be used for medications.

The Consolidated Clinical Document Architecture (CDA) standard is the only recommended standard for summary transactions.

Stepping Up Security

New security criteria in the rule reflect increased security requirements of CMS’s rule, including a requirement that systems encrypt data at rest.

New requirements also reflect updated patient engagement objectives, including a “patient accessible log” to track the use of the view, download, and transmit capabilities. Beginning in 2014, systems would be required to record a user’s identification, actions, and the health information viewed, downloaded, or transmitted and make that information available to the patient.

Support for Patient Access

In response to new patient engagement objectives, EHR technology would be required to support a patient’s ability to view, download, and transmit his or her information to a third party.

Systems must be capable of generating patient summaries, and in ambulatory settings systems must enable secure messaging with providers.

A Shift to “Base EHRs” in 2014

ONC also proposes changes to its definition of a “qualified” EHR intended to give providers more flexibility.

In response to feedback, ONC would allow professionals and hospitals the ability to implement only the EHR technology they need to demonstrate meaningful use.

Under the current definition, program participants must have EHR technology that has been tested and certified to all applicable certification criteria adopted for the setting for which it was designed. Thus, for example, an eligible professional who qualifies for an exclusion of an objective and associated measure still must have EHR technology that supports the capability.

Effective 2014, ONC’s rule would require professionals and hospitals to possess a “base EHR” that supports universal fundamental capabilities. They then would require any additional technology necessary to meet the program objectives and measures for the stage of meaningful use that they seek to meet and to capture and report clinical quality measures.

The revised definition reads: “All EPs, EHs, and CAHs must have EHR technology (including a Base EHR) that has been certified to the 2014 Edition EHR certification criteria that would support the objectives and measures, and their ability to successfully report the CQMs, for the MU stage that they seek to achieve.”

Comments on the rule will be due in early May, 60 days following publication.

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