OpenEMR Certification Stage II Meaningful Use

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Revision as of 14:51, 23 November 2013 by Neena Kumar (talk | contribs) (Neena Kumar)

Overview

This is the project page for the OpenEMR Certification Stage II Meaningful Use project, which is due before the last quarter in 2014. The goal is to have certification by the end of 2013. There are 45 Certification Criteria, which are organized into 7 different topics (Clinical, Care Coordination, Clinical Quality Measures, Privacy and Security, Patient Engagement, Public Health, and Utilization).
Here are some useful links:
  • Ongoing MU2 work by ZH Healthcare, which will be included in OpenEMR:


Completion Barometer

This barometer will track the progress of the Stage 2 MU project. See below Certification Criteria section for criteria titles.
a1* a2 a3 a4 a5 a6* a7* a8 a9 a10 a11 a12 a13 a14 a15 b1 b2 b3 b4 b5 b7 c1 c2 c3 d1* d2 d3 d4 d5 d6* d7 d8* d9* e1 e2 e3 f1* f2 f3 f5 f6 g1 g2 g3 g4
Not Started Analyzing In Progress Analyzing Complete Coding In Progress Complete Finalized
Third Party Pending


Legend Description:
  • Not Started - Not yet analyzed.
  • Analyzing In Progress - Analyzing for ONC/NIST guidelines
  • Analyzing Complete - Finished analyzing for ONC/NIST guidelines
  • Coding In Progress - Coding for ONC/NIST guidelines
  • Complete - Complete according to ONC/NIST guidelines
  • Finalized - Passes the certification testing scripts
  • Third Party Pending - Planned to be completed by third party
  • * notes Gap Eligible Criteria (Criteria categorized as "Unchanged" between 2011 and 2014 edition)


Certification Criteria

Definitions for terms used in the below Criteria wiki pages:
  • Owner - This is the "current" person/group(s) that are working on this criteria.

Clinical (170.314(a))

a1. Computerized provider order entry
a2. Drug-drug, drug-allergy interaction checks
a3. Demographics
a4. Vital signs, body mass index, and growth charts
a5. Problem list
a6. Medication list
a7. Medication allergy list
a8. Clinical decision support
a9. Electronic notes
a10. Drug-formulary checks
a11. Smoking status
a12. Image results
a13. Family health history
a14. Patient list creation
a15. Patient-specific education resources

Care Coordination (170.314(b))

b1. Transitions of care – receive, display, and incorporate transition of care/referral summaries
b2. Transitions of care – create and transmit transition of care/referral summaries
b3. Electronic prescribing
b4. Clinical information reconciliation
b5. Incorporate lab tests and values/results
b7. Data portability

Clinical Quality Measures (170.314(c))

c1. Clinical quality measures - capture and export
c2. Clinical quality measures - import and calculate
c3. Clinical quality measures - electronic submission

Privacy and Security (170.314(d))

d1. Authentication, access control, and authorization
d2. Auditable events and tamper-resistance
d3. Audit report(s)
d4. Amendments
d5. Automatic log-off
d6. Emergency access
d7. End-user device encryption
d8. Integrity
d9. Accounting of disclosures

Patient Engagement (170.314(e))

e1. View, download, and transmit to 3rd party
e2. Clinical summaries
e3. Secure messaging

Public Health (170.314(f))

f1. Immunization information
f2. Transmission to immunization registries
f3. Transmission to public health agencies – syndromic surveillance
f5. Cancer case information
f6. Transmission to cancer registries

Utilization (170.314(g))

g1. Automated numerator recording
g2. Automated measure calculation
g3. Safety-enhanced design
g4. Quality management system


Features that Are Needed (ie. "Building Blocks")

  • Prescriptions/meds/allergies need to have a RxNorm association option.
  • Production and real incorporation of fully-featured CCD and CCD(a)s at some point. (ZH is working on this)
  • Be able to connect to DIRECT. Here is home page of Direct: http://www.healthit.gov/policy-researchers-implementers/direct-project (EMR Direct provided a solution for this which has been committed into OpenEMR 4.1.2: Direct)
  • Medical problems need to have a SNOMED association option (Already supported since 4.1.1 version)
  • Need to support import of US SNOMED extension package in addition to the currently supported base international package (ie. need to be able to install/update both simultaneously). (This feature was committed to OpenEMR 4.1.2)

Estimates

  • Here is a estimate by Visolve of the time to complete each certification criteria above. The estimate is approximately 80 work weeks of effort.

Notes

Some Analysis of Proposed Guidelines (Outdated)

Difference(s) from Stage 1
Improving quality, safety, efficiency, and reducing health disparities
Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter 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.
  • Adds laboratory & radiology
  • Increased from 30% to 60%
  • Requirement is based on number of orders, not number of patients.
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.
  • Increased from 40% to 65%.
  • Includes formulary check which formerly was part of menu set
Record the following demographics
  • Preferred language
  • Gender
  • Race
  • Ethnicity
  • Date of birth
More than 80 percent of all unique patients seen by the EP have demographics recorded as structured data
  • Increased from 50% to 80%.


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 have blood pressure (for patients age 3 and over only) and height/length and weight (for all ages) recorded as structured data
  • Increased from 50% to 80%.
  • Changed from age 2 and over to age 3 and over.


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 have smoking status recorded as structured data
  • Increased from 50% to 80%.
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 has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entre EHR reporting period.
  • Increased from implementing one rule to five.
  • Must be related to five quality measures for entire reporting period.
  • Incorporates drug-drug/drug-allergy checks (formerly standalone requirement).


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 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
  • Formerly menu set item.
  • Increased from 40% to 55%.


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.
  • Formerly menu set item.


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
  • Formerly menu set item.
  • Eliminated age parameters; changed to “unique patients who have had an office visit”
Engage patients and families in their health care
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
  • Formerly menu set item.
  • More specific
  • Increased from 10% to 50%
  • Added requirement for patients to “view, download or transmit” information.
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