Posts Tagged ‘ONCHIT’

EMR “Meaningful Use” Defined By ONCHIT

Tuesday, January 5th, 2010

Doctor EMR PC

Long-Awaited Criteria – ONCHIT has finally issued regulations that define “meaningful use” of EMRs, the major qualifying criterion for the EMR adoption incentives provided by ARRA.

You can view the text of the regulations here.

Stage 1 criteria take effect in 2011. Stage 2 criteria will apply in 2013, and Stage 3 criteria in 2015 (both to be defined at a later date).

Major Elements of the Meaningful Use Rules:


Practices: Use CPOE for orders involving medications, laboratory, radiology, and referrals.
Hospitals: medications, laboratory, radiology, blood bank, PT, OT, RT, rehab, dialysis, consults, and discharge and transfer.

Orders do not have to be sent electronically to the fulfilling department (lab, pharmacy, etc.)
Practices must enter 80% of their total orders directly by the clinician into the CPOE system. Hospitals must have 10% of all orders entered by CPOE.

Clinical Checking of Orders

Real-time screening (drug-drug interactions and drug-allergy contraindications), formulary check, user ability to maintain screening rules, track user responses to alerts.

Problem List

Longitudinal current and active diagnoses coded in ICD-9-CM or SNOMED CT.
80% of unique patients must have at least one coded problem/diagnosis, with “none” being an allowed entry (hospitals and practices).


Practices only.
Must send 75% of non-controlled substance prescriptions electronically.

Active Medication List

80% of unique patients must have at least one coded entry, with “none” being an allowed entry (hospitals and practices).

Medication Allergy List

Longitudinal with allergy history.
80% of unique patients must have at least one coded entry, with “none” being an allowed entry (hospitals and practices).


Practices: preferred language, insurance type, gender, race, ethnicity, and data of birth.
Hospitals: all of the above plus date and cause of death if applicable.
80% of patients must have demographics recorded as structured data

Vital Signs

Height, weight, BP, BMI, growth charts for patients 2-20 years old, temperature, pulse.
80% of patients aged 2 and over must have blood pressure and BMI entered.
Children 2-20 must have a growth chart.

Smoking Status

Record if current smoker, former smoker, or never smoked.
Must be recorded for 80% of patients.

Structured Lab Results

Display results, translate LOINC codes, allow maintenance based on new results.
Must record as structured EHR data 50% of all results that are delivered in positive/negative or numeric format.

Patient Lists

Allow user to select, sort, retrieve, and output patient lists based on demographics, medications, and conditions.

Report Quality Measures to CMS and States

Calculate, display, and submit quality measure results

Patient Reminders

Practices only: issue based on patient preferences, demographics, conditions, and medication list.

Five Clinical Decision Support Rules

Beyond drug screening, based on demographics: diagnoses, lab results, or medication list. Real-time alerts and suggestions based on evidence. Track response to alerts.


Allow user to record and display based on eligibility response from insurer.
Must cover 80% of unique patients.

Submit Claims

Must submit 80% of all claims filed electronically.

Electronic Copy of Health Information to Patients

Allow user to create an electronic copy of test results, problem list, medication list, medication allergy list, immunizations, and procedures. Hospitals must also provide a discharge summary but not procedures.
Must provide an electronic copy of health information to requesting patients within 48 hours.

Electronic Copy of Discharge Instructions

Hospitals only.
Must provide electronically to 80% of discharged patients who request them.

Timely Patient Access to Health Information

Practices only: diagnostic results, problem list, medication list, medication allergy list, immunizations, and procedures. Within 96 hours of availability.
Must provide to 10% of unique patients.

Clinical Summary of Each Office Visit

Practices only: diagnostic results, medication list, procedures, problem list, immunizations.
Must provide for 80% of office visits.

Information Exchange

Enable electronic sending and receiving of diagnostic test results, problem list, medication list, medication allergy list, immunizations, and procedures. Hospital requirements also include a discharge summary.
Must conduct at least one test of exchanging information.

Medication Reconciliation

Compare and merge two or more medication lists into a single list that can be displayed in real time.
Must be performed in 80% of encounters and care transitions.

Submit Data to Immunization Registries

Must conduct at least one test of submitting information.

Submit Lab Results to Public Health Agencies

Hospitals only.
Must conduct at least one test of submitting information.

Submit Syndrome Surveillance Data to Public Health Agencies

Must conduct at least one test of submitting information.

Protect Electronic Patient Information

Unique identifier, emergency access for authorized users, session timeout, encryption where preferred, encryption when exchanging information, maintain audit logs, provide integrity check for recipient of electronically transmitted information, verify user identities and access privileges, record PHI disclosures.
Must conduct a security risk analysis and implement security updates.

ONCHIT Releases Operating Plan for ARRA EHR Incentives

Tuesday, May 26th, 2009

Saving For a Rainy DayThe Office of the National Coordinator for Health IT (ONCHIT) has released its operating plan for implementing the health IT provisions included in the federal stimulus package. But don’t get your hopes up. The plan is disappointingly brief and lacking in detail . . . more along the lines of “here’s what we’re going to do once we get started.” C’mon people! The clock is ticking!! Get with it.

Sadly, it’s looking more and more like the HIT provisions of ARRA will not have their intended effect: stimulating the economy. By the time ONCHIT releases its rules and guidelines, the absence of which has frozen EHR implementations, the U.S. economy will be well on its way to recovery. Sadder still, legislation that was designed to create spending has actually slowed spending.

Once again, the best laid plans of governement have gotten sidetracked in bureaucracy. Maybe we should save these EHR incentive dollars until a more considered plan can be developed.

You can view ONCHIT’s Operating Plan here.

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Federal EHR Incentives – Required Certification

Wednesday, February 25th, 2009

January 5 UPDATE – Definition of “Meaningful Use”

ONCHIT has released “Meaningful Use” regulations that will impact EMR certification and providers’ qualification for ARRA EMR incentives. Learn more here.

July 17 UPDATE – Multiple EHR Certification Groups

The Health IT Policy Committee has suggested that multiple groups engage in the certification of EHR systems. Previously, the Certification Commission for Healthcare Information Technology (CCHIT), a private organization, had a monoploy on EHR system certification. The Health IT Policy Committee also recommended that officials examine gaps between existing CCHIT certification criteria and the emerging definition of “meaningful use”.

July 16 UPDATE – Definition of “Meaningful Use”

The Health IT Policy Committee approved a work group’s revised recommendations for defining “meaningful use” of electronic health records. Current elements of the definition of “meaningful use” include:

    Allow patients to access their health records in a timely manner;

    Develop capabilities to exchange health information where possible;

    Implement at least one clinical decision support rule for a specialty or clinical priority;

    Provide patients with electronic copies of discharge instructions and procedures;

    Submit insurance claims electronically; and

    Verify insurance eligibility electronically when possible.

Read more here.

July 13 UPDATE – Definition of “Meaningful Use”

The comments period for the first release of a working definition of “meaningful use” ended on June 26. Following are links to comments submitted by a number of organizations.

    CCHIT comments
    The Markle Foundation comments
    The American Hospital Association (AHA) letter
    College of Health Information Management Executives letter
    The American Medical Association (AMA) letter and comments
    Healthcare Information Mangement Systems Society (HIMSS) comments
    eHealth Initiative comments

June 23 UPDATE – Definition of “Meaningful Use” – Standards and Certification Criteria

The HIT Standards Committee is meeting today to discuss the application of standards and certification criteria to the definition of “meaningful use” of health IT (EHR). No additional information is available at this time.

June 16 UPDATE – Definition of “Meaningful Use”

The HIT Policy Committee today offered some criteria that it feels should be part of the definition of “meaningful use”. You can view the Meaningful Use Workgroup’s June 16, 2009 update here.

April 16 UPDATE – Definition of “Meaningful Use”

A workgroup of the HIT Policy Committee has until June 16 to deliver its recommendations for a working definition of “meaningful use” of electronic health records. If the Committee approves the definition, it will be forwarded to ONCHIT for approval and adoption.

April 8 UPDATE – HIT Standards Committee and HIT Policy Committee

The HIT Standards Committee has received over 1,000 nominations, but as of today, no appointments have been made.

The HIT Policy Committee has made 13 of 20 appointments.

March 19 UPDATE – HIT Standards Committee and HIT Policy Committee

By law, the Office of the National Coordinator for Health Information Technology (ONCHIT) must announce appointments to the HIT Standards Committee and HIT Policy Committee on or before March 31, 2009. ONCHIT has not been forthcoming with news about its progress toward filling these committee posts.

March 12 UPDATE – Continuing Role for CCHIT?

During a webinar today, CCHIT Chair Mark Leavitt said he is confident that HHS will select CCHIT as the certification body identified in the stimulus law because HHS has recognized CCHIT since 2006. He thinks there is not enough time to develop a new certification group because IT systems need to be certified within the next year to qualify for stimulus package bonuses.

March 11 UPDATE – Serve on Standards or Policy Committee

The Office of the National Coordinator for Health Information Technology is seeking nominations to the HIT Standards Committee and HIT Policy Committee, both created under the American Recovery and Reinvestment Act.

The deadline for letters of nomination for both committees is March 16.  The e-mail address is  The postal address is Office of the National Coordinator, Department of Health and Human Services, 200 Independence Avenue NW, Washington, DC 20201, Attention:  Judith Sparrow, Room 729D.

March 8 UPDATE – National Institute of Standards and Technology (NIST) – Role in Developing HIT and EHR Standards

As part of the Economic Stimulus Package, the NIST will receive approximately $20 Billion to fund its development of HIT infrastructure structure and related standards, including those impacting Electronic Health Records (EHR).  You can access the NIST’s Project Statement here.

Feb. 26 UPDATE – “Billions for health records rest on NIST standards”

Great article from NextGov here.

Feb. 25 Original Post: Federal EHR Incentives – Required Certification

The American Recovery and Reinvestment Act of 2009 (Economic Stimulus Bill) provides financial incentives for physicians and other healthcare providers to adopt electronic health records (EHRs). Physicians, hospitals and health systems will be eligible for the incentives through implementation of their first EHR system or completion of an ongoing EHR project. However, in order to qualify for the incentive payments, a deployed EHR system must be “certified”.

The Certification Dilemma – The certification requirements necessary to qualify for the federal EHR incentives are not known yet and may not be defined until late 2009 (or later). As of today, the EHR certification provided by a nonprofit think tank, the Certification Commission for Healthcare Information Technology (CCHIT), is the closest relevant certification standard in effect. But don’t necessarily rely on that certification to be the one adopted by the federal government when it decides what EHR systems will qualify for the financial incentives.

Stay Informed – On a weekly basis I will be tracking certification standards as they are promulgated by the Office of the National Coordinator for Health Information Technology (ONCHIT), including notice of “comments periods” during which members of the public are invited to comment upon proposed regulations.

If you want to stay abreast of these certification developments, check back often for additional details, or subscribe to the RSS feed below to automatically receive updates.

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