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

ICSA LABS Cert Testing #2 --Tony - www.mi-squared.com 17:43, 20 July 2011 (UTC) When: Thursday, July 28, 2011 8:30 PM to Friday, July 29, 2011 12:30 AM (GMT-05:00) Eastern Time (US & Canada). Where: +1 (866) 765-0950/WebEx

We will be doing a complete ambulatory inspection of OpenEMR's OpenEMR 4. We will plan on having a 4 hour session with a couple 10-15 minute breaks.

Here is the list of procedures we will be testing and the order we will be testing them in, along with a couple randomly selected modules from the previous modular test.

Eligible Provider (Ambulatory)

   * 170.302 (n) Automate measure calculation
   * 170.304 (j) Calculate and Submit Clinical Quality Measures*
   * 170.302 (k) Submission to immunization registries*
   * 170.304 (i) Exchange Clinical Information and Patient Summary Record (combine with 170.304.f)*
   * 170.304 (f) Electronic copy of health information (combine with 170.304.i)*
   * 170.304 (h) Clinical Summaries*
   * 170.304 (b) Electronic prescribing*
   * 170.302 (b) Drug formulary checks
   * 170.302 (j) Medication reconciliation
   * 170.302 (a) Drug/Drug and Drug/Allergy Interactions
   * 170.304 (d) Patient Reminders
   * 170.304 (e) Clinical decision support
   * 170.302 (m) Patient specific education resources
   * 170.304 (g) Timely Access
   * 170.304 (a) Computerized provider order entry
   * 170.302 (h) Incorporate lab results

Security (has to be retested each time we do a pass)

   * 170.302 (o) Access control (combine with 170.302.t)
   * 170.302 (t) Authentication (combine with 170.302.o)
   * 170.302 (p) Emergency access
   * 170.302 (q) Automatic log-off
   * 170.302 (s) Integrity
   * 170.302 (u) General encryption
   * 170.302 (v) Encryption when exchanging electronic health information
   * 170.302 (r) Audit log
   * 170.302 (w) Accounting of disclosures (optional)

Testing Notes

• 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

Completed = already approved or ready to be approved as a module with ICSA Labs

Status By MU ID

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

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

See: OpenEMR_Downloads#Stable_Production_Releases_.284.0.0.29 for the current certified version Thanks to all of you and special thanks to the team at ISCA labs for their support!

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

Status and Summary --Tony - www.mi-squared.com 01:56, 12 July 2011 (UTC)

E-Prescribing

• Phyaura (<40)
  • Targeting the Relay Health modules by end of May
  • Update: May be a few days late.
• MI2/ZHH collaboration - NewCrop - (172 hrs)
  • Go-live testing happened 7/5/2011, passed with NewCrop, waiting on Sure Scripts to scheduled next phase which is a formality. --Tony - www.mi-squared.com 01:56, 12 July 2011 (UTC)
• National-eRX
  • No viable way certify with this a part of the ALL EHR certification.
• DrFirst
  • Implementation complete, "DrCloud" version of OpenEMR will get certified separately with, Dr First e-RX. --Tony - www.mi-squared.com 02:23, 12 July 2011 (UTC)

CCR/CCD

• All NIST Testing passes for CCR/CCD
  • Rxnorm codes included in CCR when feed from NewCrop eRx --Tony - www.mi-squared.com 15:07, 19 July 2011 (UTC)

Timely Access (Portal)

• Testing passes with ZHH --Tony - www.mi-squared.com 02:28, 28 June 2011 (UTC)
  • Waiting on code review
• Testing passes with internal (Cassilup) Portal --Tony - www.mi-squared.com 01:56, 12 July 2011 (UTC)

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)

• All known CQM issues addressed by Ken Chapple of Mi2 --Tony - www.mi-squared.com 23:50, 18 July 2011 (UTC)

Automated Measure Calculation

• AMC passed all NIST
• Need to ask ICSA "How do you measure the Numerator/Denominator for incorporate Lab test?"

• ISCA says we need only count automatic, can provide manual overide if desired

ISSUES

• May need to be member of HL7, may want to throw this at Todd Crabtree
• Visolve/ISCA are working on schedule for full certification, next week July 25+ --Tony - www.mi-squared.com 15:09, 19 July 2011 (UTC)

Lab Results (NIST)

• MI2 (jeremy) provided 3 test results in the format we transmit from our lab exchange to the openemr client to Visolve --Tony - www.mi-squared.com 02:01, 7 June 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 - NewCrop complete/needs merge with codebase
3. E-prescribe - NewCrop complete/needs merge with codebase
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 - complete and ready for cert testing
12. Electronic copy of PHI - complete and ready for cert testing
13. Provide clinical Summaries - complete and ready for cert testing
14. Exchange Clinical PHI - complete and ready for cert testing
15. Protect PHI
16. Automated Measure Calculation - complete and ready for cert testing

Five of the following 10 optional requirements:

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

• How to get paid for ONC Certified Use

Meaningful Use Requirement Details

1. Foundations: Security and Privacy - Done

2. Computer Physician Order Entry - ready for cert testing

3. Drug Decision Support

4. Problem List Done

5. Electronic Prescribing

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 ready for cert testing

14. Patient Reminders - Done

15. Clinical Decision Rules - ready for cert testing

16. Insurance Eligibility - Not Needed for Cert Done

17. Electronic Claims Submission - Not Needed for Cert Done

18. Patient Electronic Copy of Health Information ready for cert testing

19. Patient Electronic Access to Health Information ready for cert testing

• ZHH contributed a API for a hosted portal, ready in a few days ready for cert testing
• Interface to Microsoft Health Vault demonstrated vi Garden's HIE
• Integrated Portal - has been thru several code review loops and is starting to look good. --Tony - www.mi-squared.com 01:56, 7 June 2011 (UTC)

20 Patient Clinical Summaries - ready for cert testing

• Dependent on ability to produce on CCR Done

21. Exchange Clinical Information ready for cert testing

• Dependent on ability to produce on CCR Done

22. Medication Reconciliation Done

23. Summary Care Record for Transition of Care/Referral ready for cert testing

24. Immunization Registries ready for cert testing

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

26. Patient Specific Education resources - ready for cert testing

27. Automatic Measure Calculation ready for cert testing

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

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