How EHR standards align with meaningful use
Federal EHR standards outline the things a system must do to be certified for meaningful use. This chart lists each standard and its corresponding meaningful use requirement.
Under the federal government's meaningful use criteria, hospitals and other eligible health care providers must use an electronic health record system that meets certain EHR standards and implementation requirements.
The Office of the National Coordinator for Health Information Technology (ONC) outlined these EHR standards in a final rule released July 13 in conjunction with the meaningful use final rule, which the Centers for Medicare & Medicaid Services (CMS) unveiled the same day. (Both documents subsequently were published in the Federal Register on July 28.)
The chart below summarizes the EHR standards that correspond to each meaningful use criterion. For an EHR system to be "meaningful use certified," it first must meet each of these requirements, then undergo the EHR testing and certification process that has been outlined in a third federal rule, also written by the ONC. (As of now, only the temporary certification program final rule applies. A permanent certification program is forthcoming.)
It should be noted that there is one EHR standard that is not tied to any specific meaningful use objectives: For each meaningful use objective with a percentage-based measure, the EHR system must be able to record the numerator and denominator electronically and generate a report including the numerator, denominator and resulting percentage associated with each applicable meaningful use measure.
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Generate notifications at the point of care for drug-drug and drug-allergy indications based on medication list, medication allergy list and CPOE1. Let certain users adjust notifications for drug-drug and drug-allergy interaction checks. |
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Use CPOE system. |
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Maintain an up-to-date problem list of current and active diagnoses. |
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Generate and transmit permissible prescriptions electronically (e-prescribing). |
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Maintain active medication list. |
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Maintain active medication allergy list. |
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Record demographic information. |
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Record and chart changes in vital signs. |
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Record smoking status for patients 13 years old or older. |
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Report quality measures to CMS8 or the states. |
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Provide patients with an electronic copy of their health information upon request. |
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Provide patients with an electronic copy of their discharge instructions and procedures at time of discharge, upon request. |
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Provide clinical summaries for patients for each office visit. |
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Exchange key clinical information among providers of care and patient-authorized entities electronically. |
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Protect EHI12 created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. |
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* The final rule sets numerous standards for how EHR systems must protect EHI.
- Assign unique name/number for identifying and tracking user identity.
- Establish controls that permit only authorized users to access EHI.
- Verify that user seeking access to EHI is in fact that user, and is authorized to access such information.
- Permit authorized users to access EHI during an emergency.
- Terminate an electronic session after a predetermined time of inactivity.
- Record actions related to EHI in accordance with the HIPAA13 Security Rule.
- Let user generate and sort entries in an audit log for a specific time period.
- Detect the alteration of audit log.
- Create message digest.
- Verify upon receipt that EHI has not been altered.
- Encrypt, decrypt EHI in accordance with NIST14 standards, unless HHS determines that the use of such algorithms would pose a significant security risk for certified EHR technology.
- Encrypt, decrypt EHI when exchanged.
- Optional criterion: Record disclosures made for treatment, payment and operations.
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Implement drug-formulary checks. |
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Incorporate clinical lab-test results into EHRs as structured data. |
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Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities and outreach. |
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Send reminders to patients per patient preference for preventive or follow-up care. |
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Provide patients with timely electronic access to their health information. |
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Perform medication reconciliation at relevant encounters and each transition of care. |
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Provide summary care record for each transition of care and referral. |
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Submit electronic data to immunization registries and actual submission where required and accepted. |
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Provide electronic submission of reportable lab results (as required by state or local law) to public health agencies, and actual submission where it can be received. |
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Provide electronic syndromic surveillance data to public health agencies, and actual transmission according to applicable law and practice. |
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1 CPOE: computerized physician order entry
2 SNOMED-CT: Systematized Nomenclature of Medicine -- Clinical Terms
3 ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modification
4 NCPDP: National Council for the Prescription Drug Programs
5 NLM: National Library of Medicine
6 NTTAA: National Technology Transfer and Advancement Act of 1995
7 BMI: body mass index
8 CMS: Centers for Medicare & Medicaid Services
9 PQRI: Physician Quality Reporting Initiative
10 CCD: Continuity of Care Document
11 CCR: Continuity of Care Record
12 EHI: electronic health information
13 HIPPA: Health Insurance Portability and Accountability Act of 1996
14 NIST: National Institute of Standards and Technology
15 HL7: Health Level 7 International
16 IIS: Immunization Information Systems
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