Clinical summaries (MU2))
From OpenEMR Project Wiki
- Taken from ONC Final Rule:File:2014 Edition Cert Federal Register.pdf
(2) Ambulatory setting only – clinical summary. (i) Create. Enable a user to create a clinical summary for a patient in human readable format and formatted according to the standards adopted at § 170.205(a)(3). (ii) Customization. Enable a user to customize the data included in the clinical summary. (iii) Minimum data from which to select. EHR technology must permit a user to select, at a minimum, the following data when creating a clinical summary: (A) Common MU Data Set (which, for the human readable version, should be in their English representation if they associate with a vocabulary/code set) (B) The provider’s name and office contact information; date and location of visit; reason for visit; immunizations and/or medications administered during the visit; diagnostic tests pending; clinical instructions; future appointments; referrals to other providers; future scheduled tests; and recommended patient decision aids.
Per ONC/NIST Final Test Methods
- This item will be supported by the ZH Healthcare Care Coordination Module: http://sourceforge.net/p/zhopenemr/wiki/Care%20Coordination%20Module/