OpenEMR Certification

Meaningful Use Certification

Incentive payments under Medicare will be slower in coming. Physicians who have registered in that program must then report to CMS that they have met meaningful-use requirements over a 90-day period. Because registration begins January 3, the earliest they can attest to this is in April. The first EHR incentive checks under Medicare are expected to go out in May. The last day for physicians to begin a 90-day reporting period in 2011 is October 3.

NIST Testing Requirements

• 170.302 (a-n) General requirements --> Applies to both ambulatory and inpatient EHRs
• 170.302 (o-v) Security requirements --> Done/Certified --Tony - www.mi-squared.com 21:22, 15 March 2011 (UTC)
• 170.302 (w) Security requirement --> Done/Certified --Tony - www.mi-squared.com 21:22, 15 March 2011 (UTC)
• 170.304 (a-j) Ambulatory requirements

Project Tracking, Testing and QA for ONC Certification

• OpenEMR QA against NIST - QA using NIST Test scripts - Barometer and Results notes
• ARRA ONC MU Project Issues List - Issues list for the tracking spread sheet
• Notes from 3/21 Meeting
• Notes from 3/28 Meeting
• Notes from 4/11 Meeting

Archive Data

File:ARRA ONC MU Project-Master-20100927.pdf - --Tony - www.mi-squared.com 03:02, 28 September 2010 (UTC), this file is the last one to be tracked externally. All tracking is done here on the wiki pages now.

CCHIT_MU_2011_Project - Past meeting notes, target dates and SPRINT logs are located here as well as some team decisions about design choices.

Completion Barometer

Meaningful Use

Color Key:

Not Started

In Progress

Coded

Completed

Status By MU ID

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Status and Summary - Updated: --Tony - www.mi-squared.com 02:40, 26 April 2011 (UTC) We are really a lot closer to being ready than the barometer can show in this situation (ie: volunteer).

See: OpenEMR_Downloads#Stable_Production_Releases_.284.0.0.29

• This meets and has passed MU certification with ICSA as of 3/14/2011. The entire branch represents the OFFICIAL content that passes 17 meaningful modules. This branch represents OpenEMR as a Modular Certified EMR. Modules are as follows: 170.302 (c,d,e,f,g,i,l,o,p,q,r,s,t,u,v,w) and 170.304(c)

Thanks to all of you and special thanks to the team at ISCA labs for their support!

We are certified as a modular EHR as of 3/17/2011 ONC Certification Official Letter and Rules

• Site is: http://onc-chpl.force.com/ehrcert/EHRProductDetail?id=a0X30000003jFmdEAE&retURL=%2Fehrcert%2FEHRProductSearch&setting=Ambulatory
• Tiny URL is: http://tinyurl.com/4sgaw8a

NOTE re-branding Rules: ONC FAQ on rebranding certified EHRs

Details, Dependencies and Links to the Individual Items

Contributors are encouraged to update this page with information as they know it.

Summary of Projects that cross multiple MU

E-Prescribing

• Phyaura (<40)
  • Targeting the Relay Health modules by end of May
• MMF
  • No new updates
• NewCrop - (172 hrs)
  • Project starting ...
  • A link to Allscripts work (Modular Certification)
    • http://eprescribe.allscripts.com/Login.aspx?ReturnUrl=%2fdefault.aspx
  • National-eRX
    • Community progress on this. May be the fastest route (<10hrs)

CCD/CCR

• CCR code submitted for review, some final code
  • code committed to base - ready for cert testing --Tony - www.mi-squared.com 01:55, 3 May 2011 (UTC)
  • Need Save As and Print for feeding 18, 19 and 21.

  Validator CCR: http://vicareplus.com:8080/CCRValidator/

• Need to make sure CCD and CCR can be downloaded and viewed from the 'Document tree' (mime type issue)

Clinical Quality Measures (CQM) Reporting

• CQM development progressing, MI2 and Ensoftek took this over from Brady --Tony - www.mi-squared.com 02:22, 19 April 2011 (UTC)

• Brady provided a template report format to use a as basis
• 3 Reports completed (of 9) --Tony - www.mi-squared.com 02:35, 27 April 2011 (UTC)

Time Spent: appx 50 hrs Estimate remaining Hr: 50 hrs

Automated Measure Calculation

Need Owner --Tony - www.mi-squared.com 01:56, 3 May 2011 (UTC)

Immunization Registries

• Ensoftex and MI2 own this --Tony - www.mi-squared.com 01:59, 3 May 2011 (UTC)
  • Basic DB design updates done, CVX Codes ready
  • Needs changes to immunizations.php (3 hrs) (TONY)
  • Needs base report written (6 hrs) (RAM)
  • Needs XML (HL7) output format (10hrs) (RAM)

Patient Educational Resources

• Brady Miller accepted this --Tony - www.mi-squared.com 17:02, 3 May 2011 (UTC)
• CODE is awaiting review --Bradymiller 08:38, 4 May 2011 (UTC)

Proposal By: drbowen

I had in mind a drop down combo box that allows the physician to enter the search

term and match it with the most common web resources as listed above. The combo

box should list at least the name of the resource such as:

Mayo Clinic

eMedicine

WebMD

• ICSA confirms that providing reference to material on known PE sites is adequate --Tony - www.mi-squared.com 17:51, 28 February 2011 (UTC)

Core Requirements from the Provider Side

The required core measures are: Bold are the ones we have passed modular certification

1. CPOE ready for cert test
2. Drug-drug and Drug- Allergy checking
3. E-prescribe
4. Demographics
5. Up-to-date Problem Lists
6. Medication List
7. Allergy List
8. Vital Signs
9. Record Smoking status for age > 13
10. Implement one Clinical Decision Rule - complete and ready for cert testing
11. Report ambulatory Clinical Quality Measures
12. Electronic copy of PHI - could use print to PDF form reports
13. Provide clinical Summaries - could use print to PDF form reports
14. Exchange Clinical PHI
15. Protect PHI
16. Automated Measure Calculation

Five of the following 10 optional requirements:

1. Laboratory test results
2. Patient Lists
3. Patient Reminders - complete and ready for cert testing
4. Electronic Access PHI
5. Medication Reconciliation - ready for cert test
6. Summary Care Record
7. Immunization Registries
8. Electronic Syndromic Surveillance
9. Patient Specific Education Resources - will pass with just documentation
10. Implement Drug Formulary Checks

• How to get paid for ONC Certified Use

Meaningful Use Requirement Details

1. Foundations: Security and Privacy - Done

2. Computer Physician Order Entry - visolve has committed code to meet NIST

• Combination of eRx, Lab Results and Transactions Systems meets the requirement.

3. Drug Decision Support

• Resource needed for Lexicomp testing and completion - need to review the original test
• Phyaura's option: no external dependencies, some cost involved
  • Common interface under development that would be usable for other e-prescribing

4. Problem List Done

5. Electronic Prescribing--Tony - www.mi-squared.com 03:00, 14 December 2010 (UTC)

• Phyaura's option: no external dependencies, some cost involved as above
  • Common interface under development that would be usable for other e-prescribing
  • Merged Prescription Table with Medications Lists may cause the need for some tweaks or changes to the UI around the Meds List
  • Connie will look into creating a dummy loopback server for testing e-Rx
  • Code has been posted for review on github by Connie --Tony - www.mi-squared.com 20:21, 27 December 2010 (UTC)

6. Medication List - Done

7. Medication Allergy List - Done

8. Demographics - Done

9. Vital Signs - Done

10. Smoking Status - Done

11. Lab Test Results - Done

12. Patient Lists - Done

13. CMS Quality Reporting

• Dependent on Clinical Decision Rules, primary coding done

14. Patient Reminders - Done

15. Clinical Decision Rules - Done

16. Insurance Eligibility - Not Needed for Cert Done

17. Electronic Claims Submission - Not Needed for Cert Done

18. Patient Electronic Copy of Health Information

• Dependent on ability to produce on CCR/CCD format (Garden)
• Show XML done, but need save as XNML w/ Embedded Style and Save as HTML (Or PDF) - (ZHH)

19. Patient Electronic Access to Health Information

• Interface to Microsoft Health Vault demonstrated vi Garden's HIE

20 Patient Clinical Summaries

• Dependent on ability to produce on CCR/CCD format (Garden)

21. Exchange Clinical Information

• Dependent on ability to produce on CCR/CCD format (Garden)

22. Medication Reconciliation Done

23. Summary Care Record for Transition of Care/Referral

• Dependent on CCR for data exchange

24. Immunization Registries

• Dependent on Minor Data Changes (add CVX code to table)
• Dependent on HL7 output required

25. Electronic Syndromic Surveillance - (aka Public Surveillance) Done

26. Patient Specific Education resources

• Can reference known sites with kind of database, will add browser search tool

27. Automatic Measure Calculation

• part of CQM def, but needs owner

CQM/PQRI and Patient Data Mappings

Mapping_OpenEMR_Data_for_CCD/CCR_and_CQM - This page has a table for each of 17 basic CCD/CCR data structures that need to be extracted from OpenEMR. It also has the discrete data elements (selection lists) required for much of MU Certification.

Dropped MU Items

As of 12/30/2009, the following MUs are no longer required:

1. Advance Directives - Completed and included in 4.x release
2. Progress Note - Already part of OpenEMR

OSCON Presentation by Tony and Sam

Dr Sam Bowen and Tony McCormick were speakers at the O'Rielly Open Source Convention in Portland. I have attached the presentation.

Slide Show PDF + notes, Taking OpenEMR, a GPL EMR to ARRA Meaningful Use Certification and beyond Presentation:

• File:OpenEMR-MUCert.pdf

It was recorded for video and is available on YouTube: Watch it at 240p resolution or it freezes up after about 16 minutes ,,,,

• http://www.youtube.com/watch?v=zxd-ZJuiCEk

Blog Posts:

• Day One: http://radar.oreilly.com/2010/07/day-one-of-the-health-care-it.html
• Day Two: http://radar.oreilly.com/2010/07/vista-scenarios-and-other-cont.html
• Wrap Up: http://radar.oreilly.com/2010/07/wrap-up-of-the-health-care-it.html

Links

• Full List of Certified EHR's
• Approved Certification Bodies
• Final of NIST Test Scripts for 2011
• Main HHS Site for ONC Rules
• Wikipedia ARRA

How to Register / Attest for Certified EHR use

How do I obtain a CMS EHR Certification ID?

The unique ONC EHR Certification ID issued by the certifying body is associated with the CMS EHR Certification ID but distinct from it. The ONC EHR Certification ID is one of the “inputs” into the calculation and creation of the CMS EHR Certification ID. However, it is ultimately the CMS EHR Certification ID number which providers will use for the incentive payments.

The ONC Certified Health Product Listing functionality was updated December 24, 2010 and it now has the addition of a shopping cart to create CMS EHR Certification ID number. Users can obtain the CMS EHR Certification ID number by following these steps:

1. Go the ONC CHPL website: http://onc-chpl.force.com/ehrcert

2. Following the instructions on the site, search for the certified EHR products. There are many ways to search, but one option is to search by the ONC EHR Certification ID assigned to the vendor.

3. When the EHR product(s) is found, select the link on its row called “Add to Cart”. There is a shopping cart icon next to it.

4. When all EHR products used by the provider have been added to the cart, select the “View Cart” link at the top right which also has a shopping cart icon next to it.

5. Now in the Certification Cart section, verify the products in the cart are correct. Then, select the “Get CMS EHR Certification ID” button in the top right corner to request a CMS EHR Certification ID. However, the button will not be activated until the items in your cart meet 100% of the required criteria. If your EHR product(s) do not meet 100% of the Meaningful Use incentives, then a CMS EHR Certification ID number can not be issued.

6. Finally, you will see the CMS EHR Certification ID. It is typically a 15 digit string made up alphanumeric characters.

Bradford-Scott Summary

By 2011:

   * use computerized physician order entry for all orders including medications;
   * incorporate lab tests and results into EHRs and share results electronically with public health agencies;
   * generate lists of patients by specific condition to use for quality improvement;
   * provide clinical summaries for patients after each encounter;
   * exchange key clinical information among health professionals.

By 2013:

   * generate and transmit prescriptions electronically;
   * manage chronic conditions using patient lists and decision support tools;
   * use bar coding for medication administration;
   * offer secure patient-physician messaging capability;
   * record patient preferences in EHR.

By 2015:

   * achieve minimal levels of performance on quality, safety and efficiency;
   * give patients access to self-management tools;
   * access comprehensive patient data from all available sources;
   * conduct automated real-time surveillance on occurrences such as adverse events, disease outbreaks and bioterrorism;
   * incorporate clinical dashboards into EHR.

HHS Definition Summary

• Feb 12, 2010

The Secretary adopts the following certification criteria for Complete EHRs or EHR Modules designed to be used in an ambulatory setting. Complete EHRs or EHR Modules must include the capability to perform the following functions electronically and in accordance with all applicable standards and implementation specifications adopted in this part:

Sec. 170.304 Specific certification criteria for Complete EHRs or EHR Modules designed for an ambulatory setting.

The Secretary adopts the following certification criteria for Complete EHRs or EHR Modules designed to be used in an ambulatory setting. Complete EHRs or EHR Modules must include the capability to perform the following functions electronically and in accordance with all applicable standards and implementation specifications adopted in this part:

    (a) Computerized provider order entry. Enable a user to 
electronically record, store, retrieve, and manage, at a minimum, the 
following order types:
    (1) Medications;
    (2) Laboratory;
    (3) Radiology/imaging; and
    (4) Provider referrals.
    (b) Electronically exchange prescription information. Enable a user 
to electronically transmit medication orders (prescriptions) for 
patients in accordance with the standards specified in Sec.  
170.205(c).
    (c) Record demographics. Enable a user to electronically record, 
modify, and retrieve patient demographic data including preferred 
language, insurance type, gender, race, ethnicity, and date of birth.
    (d) Generate patient reminder list. Electronically generate, upon 
request, a patient reminder list for preventive or follow-up care 
according to patient preferences based on demographic data, specific 
conditions, and/or medication list.
    (e) Clinical decision support.
    (1) Implement rules. Implement automated, electronic clinical 
decision support rules (in addition to drug-drug and drug-allergy 
contraindication checking) according to specialty or clinical 
priorities that use demographic data, specific patient diagnoses, 
conditions, diagnostic test results and/or patient medication list.
    (2) Alerts. Automatically and electronically generate and indicate 
in real-time, alerts and care suggestions based upon clinical decision 
support rules and evidence grade.
    (3) Alert statistics. Automatically and electronically track, 
record, and generate reports on the number of alerts responded to by a 
user.
    (f) Electronic copy of health information. Enable a user to create 
an electronic copy of a patient's clinical information, including, at a 
minimum, diagnostic test results, problem list, medication list, 
medication allergy list, immunizations, and procedures in:
    (1) Human readable format; and
    (2) On electronic media or through some other electronic means in 
accordance with:
    (i) One of the standards specified in Sec.  170.205(a)(1);
    (ii) The standard specified in Sec.  170.205(a)(2)(i)(A), or, at a 
minimum, the version of the standard specified in Sec.  
170.205(a)(2)(i)(B);
    (iii) One of the standards specified in Sec.  170.205(a)(2)(ii);
    (iv) At a minimum, the version of the standard specified in Sec.  
170.205(a)(2)(iii); and
    (v) The standard specified in Sec.  170.205(a)(2)(iv).
    (g) Timely access. Enable a user to provide patients with online 
access to their clinical information, including, at a minimum, lab test 
results, problem list, medication list, medication allergy list, 
immunizations, and procedures.
    (h) Clinical summaries.
    (1) Provision. Enable a user to provide clinical summaries to 
patients for each office visit that include, at a minimum, diagnostic 
test results, problem list, medication list, medication allergy list, 
immunizations and procedures.
    (2) Provided electronically. If the clinical summary is provided 
electronically it must be:
    (i) Provided in human readable format; and
    (ii) On electronic media or through some other electronic means in 
accordance with:
    (A) One of the standards specified in Sec.  170.205(a)(1);
    (B) The standard specified in Sec.  170.205(a)(2)(i)(A), or, at a 
minimum, the version of the standard specified in Sec.  
170.205(a)(2)(i)(B);
    (C) One of the standards specified in Sec.  170.205(a)(2)(ii);
    (D) At a minimum, the version of the standard specified in Sec.  
170.205(a)(2)(iii); and
    (E) The standard specified in Sec.  170.205(a)(2)(iv).

[[Page 2047]]

    (i) Exchange clinical information and patient summary record.
    (1) Electronically receive and display. Electronically receive a 
patient's summary record, from other providers and organizations 
including, at a minimum, diagnostic tests results, problem list, 
medication list, medication allergy list, immunizations, and procedures 
in accordance with Sec.  170.205(a) and upon receipt of a patient 
summary record formatted in an alternate standard specified in Sec.  
170.205(a)(1), display it in human readable format.
    (2) Electronically transmit. Enable a user to electronically 
transmit a patient summary record to other providers and organizations 
including, at a minimum, diagnostic test results, problem list, 
medication list, medication allergy list, immunizations, and procedures 
in accordance with:
    (i) One of the standards specified in Sec.  170.205(a)(1);
    (ii) The standard specified in Sec.  170.205(a)(2)(i)(A), or, at a 
minimum, the version of the standard specified in Sec.  
170.205(a)(2)(i)(B);
    (iii) One of the standards specified in Sec.  170.205(a)(2)(ii);
    (iv) At a minimum, the version of the standard specified in Sec.  
170.205(a)(2)(iii); and
    (v) The standard specified in Sec.  170.205(a)(2)(iv).

ONC Meaningful Use - Final Rules for 2011

Health and Human Services - Standards & Certification

• http://healthit.hhs.gov/portal/server.pt?open=512&objID=1153&mode=2

ONC Initiatives

• http://healthit.hhs.gov/portal/server.pt?open=512&objID=1497&parentname=CommunityPage&parentid=1&mode=2&in_hi_userid=10741&cached=true

NIST Test Scripts

• http://xw2k.nist.gov/healthcare/use_testing/index.html

14 organizations have applied to become ONC-ATCB so CCHIT will definitely not be the only one.

• http://community.advanceweb.com/blogs/nurses_17/archive/2010/06/23/onc-establishes-temporary-certification-program-for-ehrs.aspx

Archived Pages

• CCHIT Topics - Archived