Clinical Architecture Blog

Spring 2015 Update

This is a brief intermission from your regularly scheduled blog entries…

I wanted to pop in and share with you an update from our offices in Carmel, Indiana. This is a slight departure from our usual blog content, but we wanted let you know what’s been going on at Clinical Architecture so far this year.

HIMSS15

Last month we made the quick drive up to Chicago for HIMSS15 and had a great week giving demos, discussing business, seeing old friends and meeting new people. One of the things we did different this year was to replace our usual gadget raffle with a donation sweepstakes. Each day we had a drawing and the winner received the opportunity to designate a charity to receive a $500 donation. The response to this was amazing and I was the lucky person who got to notify the winners. Not only were they excited they won, they were all truly passionate about giving back and thankful for the opportunity to select a charity to receive the donation. Here are the charities the winners selected:

Our booth at HIMSS15:

 



New Location

In March, we opened an office in Salt Lake City, Utah. Our Chief Informatics Officer, Shaun Shakib, is holding down the fort at this new location and enjoying a beautiful view of the mountains.

View from the Salt Lake City Office:

 

New Faces

We are welcoming several new faces to our team this spring. Stephanie Broderick has joining Clinical Architecture as Vice President of Product Management. Stephanie brings over 25 years of product management and software development leadership to Clinical Architecture, with 20 of those years spent creating healthcare IT solutions for First Databank and Medi-Span. We are also adding to our Customer Support and QA groups with several recent graduates from Indiana University and Xavier University. We are always looking for great talent. Let us know if you or someone you know is interested in working with us.
 

Cool New Products

We are excited to announce we are launching a new product this summer. Keep your eye out for updates about our stand alone content delivery system, which will simplify obtaining and updating the terminology assets you need.
 

Come and see us!

We are looking forward to HIMSS16 in Las Vegas next year! But before then, you can visit us at this year’s AHIMA show in New Orleans, Louisiana. We will be at the Annual AHIMA Convention September 27th – 30th at booth 551. Stop by and see us if you are attending!
 

Charlie will continue your regular scheduled blogging with his series about ICD-10 next in the next few weeks.

Thanks!

Amanda O'Rourke, Director of Marketing
Posted: 5/15/2015 6:21:04 AM by Amanda O'Rourke | with 0 comments

Understanding ICD-10-CM - Part II - What's In A Code?

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To understand a terminology it is important to understand its history, coding scheme, content model, the intended use cases and editorial policy.  In my previous post, I reviewed the origin of ICD-10.  In this post I am going to spend some time talking about the ICD coding scheme and, to be honest, rant a little about structured coding schemes in general.

A coding scheme is the method that is used to assign an identifier to the terms in a terminology.  In the history of our industry coding schemes have been important and in some cases iconic.  Not sure what I mean?  I am sure at least some of you reading this post can look at the following list of codes and identify the source of each on sight.  In fact, there are likely some of you that can tell me what the term is for a few of those codes. 

1.  55454-3
2.  250.02
3.  E11.9
4.  55289-211-60
5.  3E013VG
6.  1-800-783-3637

 (Let me know if you get them all – no cheating – answers at the end of the post)
 
The fact that these codes are recognizable is not an accident.  In some cases it is just an iconic pattern and in others it is all part of the logic used to create them.  This is because all but one of the above codes is something called a meaningful, or structured, code.

As people we do not typically communicate with codes.  Codes are something we created so computers could better cope with the ambiguities of human language and conception.  So the target audience for codes is computers, or more appropriately, software.  The only reason we need to work with codes is so  we can pick the right codes to properly convey information to our silicone-based counterparts.  Historically our ability to interface with software has been, for lack of a better word, rustic. 

In many cases this required some of us (the lucky ones?) to learn the language of codes so we could speak directly to the software.  The problem is, our brains are not typically wired for codes. 

Magic Number Seven

In studies conducted during the 1950s it was shown that the capacity of a typical person’s working memory is seven things.  This led to what has been dubbed the “magic number seven” by psychologists.   

On May 4, 1955 (60 years ago to the day – next Monday), psychologist George A. Miller wrote a fascinating paper on the topic that begins with a great paragraph about the number seven:
GeorgeAMiller.jpg

“My problem is that I have been persecuted by an integer. For seven years this 
number has followed me around, has intruded in my most private data, and has 
assaulted me from the pages of our most public journals. This number assumes a variety of disguises, being sometimes a little larger and sometimes a little smaller than usual, but never changing so much as to be unrecognizable. The persistence with which this number plagues me is far more than a random accident. There is, to quote a famous senator, a design behind it, some pattern governing its appearances. Either there really is something unusual about the number or else I am suffering from delusions of persecution.”

Dr. Miller has engaging writing style and  the paper itself is an enjoyable read, if a bit steep at times.  It was being written during a the early days of information theory. In the paper he explores our human limitations with respect to retaining and processing unidimensional information.  He also describes coping mechanisms that we employ to expand these limits.

 “[The] span of absolute judgment and the span of immediate memory impose severe limitations on the amount of information that we are able to receive, process, and remember. By organizing the stimulus input simultaneously into several dimensions and successively into a sequence of chunks, we manage to break (or at least stretch) this informational bottleneck.”

And concludes with his thoughts on the number seven:

“And finally, what about the magical number seven? What about the seven wonders of the world, the seven seas, the seven deadly sins, the seven daughters of Atlas in the Pleiades, the seven ages of man, the seven levels of hell, the seven primary colors, the seven notes of the musical scale, and the seven days of the week? What about the seven-point rating scale, the seven categories for absolute judgment, the seven objects in the span of attention, and the seven digits in the span of immediate memory? For the present I propose to withhold judgment. Perhaps there is something deep and profound behind all these sevens, something just calling out for us to discover it. But I suspect that it is only a pernicious, Pythagorean coincidence.”

(If this was a informatics nerd showdown this is where Dr. Miller would drop the microphone...Respect)
 
This notion of “chunking” or organizing information into patterns and/or applying some logic to the organization of those bits is a brain hack that allows us to expand beyond our natural limitations.
Structured coding schemes take advantage of this hack by chunking meaningful information into short codes so that we can remember blocks of information and when applicable use logic to determine the rest.  This is evident in telephone numbers (3 digit areas code, 3 digit prefix – 4 digit suffix), postal codes (5 digit number), social security number (3 digit code, 2 digit code, 4 digit code) and of course ICD codes.

In fact if you look at the code examples I listed in the “quiz” you can see evidence of this type of mechanism.  That’s right…I hacked your brain.

The ICD Scheme

The coding scheme for ICD family has been a logical hierarchy for a while now.  From ICD-6 through ICD-9 it has been a numeric three digit root code where the first two digits represented a category and the third digit represented a significant axis, like anatomic location.  This base code (referred to as the “rubric”) is followed by a period and then up to two additional digits representing the etiology and sub-classification.  In ICD9 they later added the V and E codes into the first position to support external causes, clinical modifiers. 

The coding scheme in ICD-10 is still a logical hierarchy, but it has adopted an alphanumeric approach which gave it some room to maneuver.  Like its predecessor, it starts with a three byte rubric.  In ICD-10 the rubric represents a category.  In the international ICD-10 the rubric is a letter followed by two digits.  In the 2011 version of ICD-10-CM this was changed to allow the third character to be a digit or a letter, due to the need to expand the rubrics. In the 2014 edition of ICD-10-CM there are 567 codes where the character digit is an ‘A’ and 9 codes where the third character is a B.
 
The General Structure

In general the rules of the ICD-10-CM scheme are as follows:
  • Consists of three to seven characters
  • First character is alpha (All letters used except 'U' - 'U' are not invited...)
  • Second character is numeric
  • Third character can be alpha or numeric
  • Decimal placed after the first three characters
  • Fourth, fifth, sixth, and seventh digits can be alpha or numeric

Here is a basic picture of a full seven digit ICD-10-CM code:


ICD10_Structure.png
 
Not all codes include all of the positions and the visit encounter digit is typically used for injury and external cause-related codes.

The Logical Hierarchy

A simple example of the hierarchical nature of the ICD-10-CM structure for a neoplasm code is illustrated below:
 
D30 Benign neoplasm of urinary organs
D30.0 Benign neoplasm of kidney
D30.00 Benign neoplasm of unspecified kidney
D30.01 Benign neoplasm of right kidney
D30.02 Benign neoplasm of left kidney
 
You will notice that:
  • The category of D30 represent the type of neoplasm and the anatomic region (in this case)
  • The anatomic location of kidney is the ‘0’ in the fourth position
  • Unspecified is the ‘0’ in the fifth position
  • Right is the ‘1’ in the fifth position
  • Left is the ‘2’ in the fifth position
Neoplasms and diseases tend to follow this simple pattern.  But the positions of the relative aspects can vary based on the category.  The values used for a given anatomic location or laterality are mostly consistent but that is generally the same as inconsistent so you should not rely on them programmatically.
For an injury code you will notice that the structure is a little more involved:

M80 Osteoporosis with current pathological fracture
M80.0 Age-related osteoporosis with current pathological fracture
M80.00 Age-related osteoporosis with current pathological fracture, unspecified site
M80.00XA Age-related osteoporosis with current pathological fracture, unspecified site,
initial encounter for fracture
M80.00XD Age-related osteoporosis with current pathological fracture, unspecified site,
subsequent encounter for fracture with routine healing
M80.00XG Age-related osteoporosis with current pathological fracture, unspecified site,
subsequent encounter for fracture with delayed healing
M80.00XK Age-related osteoporosis with current pathological fracture, unspecified site,
subsequent encounter for fracture with nonunion
M80.00XP Age-related osteoporosis with current pathological fracture, unspecified site,
subsequent encounter for fracture with malunion
M80.00XS Age-related osteoporosis with current pathological fracture, unspecified site,
sequela
 
The seventh character is sometimes referred to as the extension.  For injuries and external causes the codes that are used for the encounter types are:
  • A - Initial encounter
  • D - Subsequent encounter
  • S – Sequelae (a secondary result)
For fractures specifically addition codes are needed to reflect additional fracture-related details:
  • A - Initial encounter for closed fracture
  • B - Initial encounter for open fracture
  • D - Subsequent encounter for fracture with routine healing
  • G - Subsequent encounter for fracture with delayed healing
  • K - Subsequent encounter for fracture with nonunion
  • P - Subsequent encounter for fracture with malunion
  • S - Sequelae
The extension always goes in the seventh character.  If there is no value for the sixth character, as in the example above, is it filled in with an ‘X’ (like a short cartoon expletive…).

Rule 6! ... There is no… rule 6

In some states is it illegal to borrow your neighbors vacuum cleaner and in others it isn’t.  The logical rules of the ICD-10-CM coding scheme are like that.  In some sections of the terminology (based on a range of initial alpha characters) the rules for the structure shift around and in some cases the rules within a given neighborhood are violated out right.  What this means is that you cannot rely on the "logical" rules.  This leads me to ask,  why even pretend to have rules? and… when can I get my vacuum cleaner back?

Logical Coding Scheme Rant – as promised

Logical hierarchy coding schemes represent an interesting dichotomy.  Like their more expressive cousin, mnemonics, they were born in a time when the population of code systems was limited to a degree that a typical person could use brain hacking to reasonable access them. The problem with using this approach today is that the same structural rigor that allows us to remember a meaningful code imposes limitations on the amount of information that can be represented in that structure. 

For example, the first digit of the ICD-10 rubric has exactly 26 possible values (A-Z) and prior to 2015, each initial alpha can have 100 possible values (00-99). That gave us an upper limit of 2600 rubrics.  Beyond the rubric this also means that each position in the code has a limit of 10-36 values depending on whether you allow number, letters or both.  In the case of ICD-10-CM this limitation created an issue when some of the rubrics ran out of space (like ‘C7-’), which required a decision to be made; should new codes be added into other rubrics where there is space available or break the previously existing rules that said a rubric was a letter followed by two digits?  Obviously, they chose the latter.  The reason for a meaningful code is that it is predictable and we rely on that predictability in our minds and, for many of us, in our software’s logic.  How many systems had a regular expression that expects a letter followed by two digits to recognize or validate an ICD-10-CM rubric?

A logical hierarchy coding scheme also limits how the information can be represented.  Specifically as the structure of the code precludes anything other than a mono-hierarchy.  Unless you want to be in the business of duplicating codes.  This also means that if you want to change the location of a term in the hierarchy you need to change its code.   The National Drug Code (NDC) is a good example of this.  The first two bytes historically represented the labeler or manufacturer.   In the unlikely event that one of these pharma giants purchases another… the meaningful code becomes somewhat less meaningful.

The Donut ConundrumDonut.png

Structured coding schemes are like donuts, I like them, but they ultimately lead to regret.  As an engineer, I am drawn to structured codes like a moth to a flame.  It is what I “grew up” with and it is much easier to remember a structured code than a thirty six byte GUID (global unique identifier).  However, whenever I succumb to that siren song and create something with the limitation of a central number wheel or a logical structure, it almost always results in a hard choice or rework down the road.  Structured coding schemes are the comfort food from our software past that should be removed from the terminology food pyramid.

The Desiderata

In his “desiderata for controlled medical vocabularies”, Dr. James Cimino does an excellent job of explaining why meaningful codes are problematic and suggests instead what he calls a nonsemantic concept identifier.  I would go a step further and suggest that an identifier that is not a GUID also has limitations when it comes to creating and extending terminology… but that is a diatribe that would be better in a separate article.

Invisible Terminology

I have a favorite guiding principle that you could apply to all user experience situations:

Technology is at its very best when it’s invisible. When you’re conscious only of what you’re doing, not the technology you’re doing it with.


We need to evolve to the point where the terminologies we use to drive our applications at the point of care do not limit the end user or require them to memorize codes to be efficient.  We will know we are doing it right when we stop talking about it.   If you wonder if technology can make this happen, answer the following question: How often do you dial an actual telephone number on your smart phone?

In my next post I will go into the overall structure of ICD-10-CM and provide more pragmatic insight for those of us that will be, and are, working with it. 

Thanks for Reading!
 
Answers to the “quiz”
   Code          Source      Term                                                       
1. 55454-3        LOINC       Hemoglobin A1C
2. 250.02         ICD-9-CM    Diabetes Mellitus without complications
3. E11.9          ICD-10-CM   Type 2 Diabetes Mellitus without Complications
4. 55289-211-60   NDC         GLUCOPHAGE 500 MG TABLET [PD-RX PHARM 60ea F/C]
5. 3E013VG        ICD-10-PCS  Intro of Insulin into SubQ Tissue, Percutaneous Approach
6. 1-800-783-3637 US Phone    Stanley Steemer (1-800-STEEMER) (go ahead... sing the rest)
 

Posted: 4/29/2015 9:59:16 PM by Charlie Harp | with 0 comments

Clinical Architecture at HIMSS 2015

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At Clinical Architecture we are gearing up for the HIMSS conference next week. 

We will be in booth #2074 and would be delighted if you stopped by and said hello.

If you are attending, we know you will be busy and there are a lot of booths to visit.  
Here are the top ten reasons YOU should visit the Clinical Architecture booth.  

Top Ten Reasons to Visit the CA Booth at HIMSS15

10            

Experience Symedical, a modern commercial terminology management platform, in action.
 
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9


Try to beat Symedical in a map challenge. 
(Can you map 10 before it maps 1000? 10,000?...puny human)


 
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8


Check out the new SIFT engine and see the future of Clinical Language Processing

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7


Terminology Themed Chocolate

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6

Meet members of the Clinical Architecture team and ask questions… for FREE!

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5

Learn how true software assisted semantic mapping can improve quality and reduce your costs.
 
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4


Visit with our smart and savvy neighbors in the Apelon booth.
 
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3

Check out our new Content Cloud and see how simple staying current can be.
 
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2

See how you can easily manage terminologies across your entire enterprise or client base with our Content Governance Architecture.

 
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1


Learn show how you can leverage the best commercial semantic platform in your solution with our powerful API’s.

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Fabulous Prizes

For my blog readers I am doing a little something special. 

If you register here and visit our booth (2074), you will receive an Amazon Fire TV stick. 
 
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Supplies are limited so be quick about it.   

We will also be raffling off a $500 donation to the charity of one lucky winners choice, each day of the show.

Regardless of the reason, you should stop by booth 2074, meet some nice people, see some cool software and talk about healthcare terminology. 

That’s right… we know how to party.

I hope to see you there!

Charlie


Posted: 4/6/2015 10:09:37 PM by Charlie Harp | with 1 comments

Understanding ICD-10-CM - Part I - Origin Story

 
ICD10CM_Part1_header-(1).png
Lately I have taken some interest in ICD-10-CM.  Be advised that I tend to write these blogs for the clinical engineer or architect, not for the informaticist, clinician, or nosologist (though I am happy to have them as readers as well).

To understand any terminology you first need to understand its history; why was it built and how has it evolved or mutated over time.

ICD-10-CM, along with other "international" classification taxonomies are curated by the World Health Organization or WHO (not to be confused with "The Who" … though you can see signs of classification in many of their song titles).

The ICD in ICD-10-CM stands for “international classification of diseases”, the “10” is the revision, and the “CM” stands for “Clinical Modification”.

(It should be noted that there are other ICDs as well, ICD-O-3 is an oncology classification used by cancer registries.  They are not related ontologically in any way.  But that is the subject for another post).

Along Time Ago in a Green House Far Far Away…

The origin of the ICD goes back to the late 1700s.  French physician and botanist, François Boissier de Sauvages de Lacroix, published his treatise, "Nosologia Methodica" in 1763.  Sauvages, as he was known, was one of the early nosologists (nosology = the branch of medical science dealing with the classification of diseases) that inspired many who followed in his footsteps.  The drivers for many of the early attempts at establishing these classifications schemes were related to tracking morbidity statistics (take that population health!). Sauvages died at the age of 59, three years after his treatise was published.  In a twist of irony, I was unable to find a record of his cause of death.

Jump forward to 1860.  At the International Statistical Congress held in London, Florence Nightingale made a proposal that ultimately resulted in the first model of systemic collection of hospital data for the purposes of tracking causes of death. 

In 1893, the “Bertillon Classification of Causes of Death” was introduced by Jacques Bertillon, a French physician.  This classification system was based on the principle of distinguishing between general diseases and those localized to a particular organ or anatomical sites.  In 1900, it was adopted by the American Public Health Association (APHA) and was re-branded as the “International Classification of Causes of Death”.  At this time the ICD contained 161 primary codes (some with modifiers).  The code was a number and the modifier was a letter. For example:

146. Burns
A) by fire
B) by corrosive substance

What is interesting is that this common way of presenting a list (that we all use) has over time become the pattern for structuring an identifier.

I have included a few excerpts from the “prefactory” of the pamphlet provided to the assembled reviewers.

“The time is especially suitable for the general adoption of a uniform classification of causes of death, to the end that the mortality data of the coming century may be more thoroughly comparable than at present.”

“The Bertillon classification is not presented as by any means a perfect system of classification of causes of death. No perfect system has ever been devised, and should there be, the progress of medical science would in time render it obsolete.”

When you reflect on it, it is both amazing and terrible to consider that the topics and issues we discuss today are not that different than those discussed over a century ago.  I especially like the last sentence as it shows they understood that terminologies in healthcare are not static and will undoubtedly drift over time … a concept many people fail to grasp in healthcare IT today.

At the conference in 1900 they also decided that they would meet every 10 years to review and revise the ICD.

ICD_trio.png
 
What we have here is an origin story.  Like every good origin story you examine the event that created our hero (or villain) to determine why they chose the path we find them on today.  For ICD, it started out about death.  “What killed these people?” was the question it was meant to answer and track.  It was also about statistics, not about a patient (they were already dead…).  This makes sense because at that time the available technology (paper) could only be used retrospectively and with much effort.

So, like time, the ICD marches on…

For many cycles minor revisions were made.  In 1946 the 6th revision (ICD-6) was released. This revision expanded the ICD to include morbidity as well as mortality conditions and was renamed accordingly to “International Statistical Classification of Diseases, Injuries and Causes of Death”.  The addition of injuries and diseases also introduced the need to add new modifiers for anatomic location.  This revision also introduced the alphabetic index to accompany the tabular index to aid in finding the appropriate code as the number of terms had increased significantly.   

This is the point at which ICD shifted from a focus on death to a focus on people's problems … and death.  This allowed people that were tracking statistics retrospectively to evaluate not just what killed people but also what was hurting and afflicting people. This was especially useful when assessing the labor force or your military capabilities.

The 7th (1955) and 8th (1965) revisions were limited mostly to corrections and minor updates. 

ICD-9

The 9th revision (ICD-9) was introduced in 1975 and once again ICD was expanded.  This time there was a contingent who wanted to use the ICD to evaluate medical care.  To do this they wanted to revise the taxonomy itself to have an organ system focus and wanted additional detail. This was in part due to the advent of data processing systems (and might be loosely related to the popularity of disco … but I have no evidence to support that).

Up to this point, consumers had been using ICD for statistics and retrospective reporting for decades.  Now, a new group of consumers are introduced who need a code system in order to document what is happening to a patient for tracking and billing.  One use is population reporting and the other is, arguably, clinical.  The two groups disagreed about how they should proceed at the time, based upon the two different use cases.  In the end, they decided to compromise and leverage the ICD for these two distinctly different purposes.  This is the point, dear reader, when our hero became a villain. (Insert ominous music of your choice here).

Why would I say this? I believe when you take a terminology designed to solve a specific problem and try to use it to solve another, different, problem you create an architectural compromise. Once compromised, the appropriateness of that terminology for either use case becomes fuzzy, as each end pulls aspects of the architecture to suit their disparate purposes.  After a while, the terminology is so compromised that it becomes unwieldy and is not suitable for any purpose. (Climbing down from my soapbox…)

It has been almost 40 years since ICD-9 was introduced and we, here in the United States, are still essentially on that revision. The most recent version has about 17k terms.

ICD-10

ICD-10 was introduced in 1990 (yes – a quarter century ago).  This international version of the classification is used in about 100 countries for cause of death reporting and statistics.  Some countries, like Australia and Canada have modified versions.

The current version of the standard international ICD-10 has just shy of 18,000 terms.  It's major difference from ICD-9 is the coding scheme which has shifted from numeric to alpha-numeric. (because remembering codes is like cheating...). 

ICD-10-CM

Today in the United States we are set to adopt an expanded version of ICD-10 called ICD-10-CM, where the CM stands for Clinical Modification.  The "modified" version is significantly different from ICD-10 in that it expands each of the standard ICD-10 codes with additional granularity (like laterality, trimester, encounter type and complications).  It also adds a number of causes, places, activities and other healthcare codes.  The net result is a classification system with over 90,000 codes.  

ICD-10-CM is the version we will explore in the next post in this series.

Here is a graphical timeline showing the classification name, focus and polulation.  I am not a historian so if I missed something or got something wrong, feel free to let me know.

ICD_Timeline2.png


Posted: 3/30/2015 11:50:27 PM by Charlie Harp | with 1 comments

Stage 3 Meaningful Use – Objectives and Measures Summary

On Friday the Centers for Medicare and Medicaid Services released the proposed rule for Stage 3 Meaningful Use Criteria.  The full text of the 301 page document can be found here.

A downloadable version of this summary is available here.

The document outlines eight program objectives, their scope and how they intend to measure them. 
The timeframe of the new measures is the end of 2017.

What follows is a high level summary of the proposed rule.   If you wish to examine the details or the context for each item summarized please refer to the full document as referenced above.

Objective 1: Protect Patient Health Information (Page 60)

Protect electronic protected health information (ePHI) created or maintained by the certified EHR technology (CEHRT) through the implementation of appropriate technical, administrative, and physical safeguards.

Proposed Measure: Conduct or review a security risk analysis in accordance with the requirements for administrative safeguards (under 45 CFR 164.308(a)(1)), including addressing the security of data stored in CEHRT in accordance with requirements of technical safeguards (under 45 CFR 164.312(a)(2)(iv)) and general rules (under 45 CFR 164.306(d)(3)), implement security updates as necessary, and correct identified security deficiencies as part of the provider's risk management process.

Under this proposed measure, a risk analysis must assess the risks and vulnerabilities to ePHI created or maintained by the CEHRT and must be conducted or reviewed for each EHR reporting period, which, as proposed in this rule, would be a full calendar year, and any security updates and deficiencies identified should be included in the provider's risk management process and implemented or corrected as dictated by that process.
 
They propose the timing or review of the security risk analysis to satisfy this proposed measure must be as follows:
  • Eligible providers, eligible hospitals, and critical access hospitals must conduct the security risk analysis upon installation of CEHRT or upon upgrade to a new Edition of certified EHR Technology. The initial security risk analysis and testing may occur prior to the beginning of the first EHR reporting period using that certified EHR technology.
  • In subsequent years, a provider must review the security risk analysis of the CEHRT and the administrative, physical, and technical safeguards implemented, and make updates to its analysis as necessary, but at least once per EHR reporting period.

Objective 2: Electronic Prescribing (page 67)

Eligible providers must generate and transmit permissible prescriptions electronically, and eligible hospitals and critical access hospitals must generate and transmit permissible discharge prescriptions electronically (eRx).  The objective has different measures for eligible providers and hospitals.
 
Proposed Eligible Provider Measure: More than 80 percent of all permissible prescriptions written by the eligible provider are queried for a drug formulary and transmitted electronically using CEHRT.
 
Measure Denominator: Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period or Number of prescriptions written for drugs requiring a prescription in order to be dispensed during the EHR reporting period.
 
Measure Numerator: The number of prescriptions in the denominator generated, queried for a drug formulary, and transmitted electronically using CEHRT.
 
Measure Threshold: The resulting percentage must be more than 80 percent in order for an EP to meet this measure.
 
Measure Exclusions: Any EP who: (1) writes fewer than 100 permissible prescriptions during the EHR reporting period; or (2) does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his or her EHR reporting period.
 
Proposed Eligible Hospital/Critical Access Hospital Measure: More than 25 percent of hospital discharge medication orders for permissible prescriptions (for new and changed prescriptions) are queried for a drug formulary and transmitted electronically using CEHRT.
                            
Measure Denominator: The number of new or changed prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances for patients discharged during the EHR reporting period.
 
Measure Numerator: The number of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically.
 
Measure Threshold: The resulting percentage must be more than 25 percent in order for an eligible hospital or CAH to meet this measure.
 
Measure Exclusion: Any eligible hospital or CAH that does not have an internal pharmacy that can accept electronic prescriptions and there are no pharmacies that accept electronic prescriptions within 10 miles at the start of their EHR reporting period.
 

Objective 3: Clinical Decision Support (page 75)

Implement clinical decision support (CDS) interventions at a relevant point in clinical workflows focused on improving performance on high-priority health conditions.
Providers are encouraged to implement CDS related to quality measurement and improvement goals on the following areas:
  • Preventive care.
  • Chronic condition management.
  • Heart disease and hypertension.
  • Appropriateness of diagnostic orders or procedures such as labs, diagnostic imaging, genetic testing, pharmacogenetic and pharmacogenomic test result support or other diagnostic testing.
  • Advanced medication-related decision support, to include pharmacogenetic and pharmacogenomic test result support.
Proposed Measures: EPs, eligible hospitals, and CAHs must satisfy both measures in order to meet the objective:
 
Measure 1: Implement five clinical decision support interventions related to four or more CQMs at a relevant point in patient care for the entire EHR reporting period. Absent four CQMs related to an EP, eligible hospital, or CAH's scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions.
 
Measure 2: The EP, eligible hospital, or CAH has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period.
 
Measure 2 Exclusion: For the second measure, any EP who writes fewer than 100 medication orders during the EHR reporting period.
 

Objective 4: Computerized Provider Order Entry (page 81)

Use computerized provider order entry (CPOE) for medication, laboratory, and diagnostic imaging orders directly entered by any licensed healthcare professional, credentialed medical assistant, or a medical staff member credentialed to and performing the equivalent duties of a credentialed medical assistant; who can enter orders into the medical record per state, local, and professional guidelines.
 
Proposed Measures: An EP, eligible hospital or CAH must meet all three measures.
 
Proposed Measure 1: More than 80 percent of medication 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 computerized provider order entry.
 
To calculate the percentage, CMS and ONC have worked together to define the following for this measure:
 
Measure Denominator: Number of medication orders created by the EP or authorized providers in the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
 
Measure Numerator: The number of orders in the denominator recorded using CPOE.
 
Measure Threshold: The resulting percentage must be more than 80 percent in order for an EP, eligible hospital, or CAH to meet this measure.
 
Measure Exclusion: Any EP who writes fewer than 100 medication orders during the EHR reporting period.
 
Proposed Measure 2: More than 60 percent of laboratory 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 computerized provider order entry.
 
To calculate the percentage, CMS and ONC have worked together to define the following for this measure:
 
Measure Denominator: Number of laboratory orders created by the EP or authorized providers in the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
 
Measure Numerator: The number of orders in the denominator recorded using CPOE.
 
Measure Threshold: The resulting percentage must be more than 60 percent in order for an EP, eligible hospital, or CAH to meet this measure.
 
Measure Exclusion: Any EP who writes fewer than 100 laboratory orders during the EHR reporting period.
 
Proposed Measure 3: More than 60 percent of diagnostic imaging 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 computerized provider order entry.
 
To calculate the percentage, CMS and ONC have worked together to define the following for this measure:
 
Measure Denominator: Number of diagnostic imaging orders created by the EP or authorized providers in the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
 
Measure Numerator: The number of orders in the denominator recorded using CPOE.
 
Measure Threshold: The resulting percentage must be more than 60 percent in order for an EP, eligible hospital, or CAH to meet this measure.
 
Measure Exclusion: Any EP who writes fewer than 100 diagnostic imaging orders during the EHR reporting period.
 

Objective 5: Patient Electronic Access to Health Information (Page 89)

The EP, eligible hospital, or CAH provides access for patients to view online, download, and transmit their health information, or retrieve their health information through an API, within 24 hours of its availability.
 
Proposed Measures: EPs, eligible hospitals, and CAHs must satisfy both measures in order to meet the objective:
 
Proposed Measure 1: For more than 80 percent of all unique patients seen by the EP or discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23): (1) The patient (or patient-authorized representative) is provided access to view online, download, and transmit their health information within 24 hours of its availability to the provider; or (2) The patient (or patient-authorized representative) is provided access to an ONC-certified API that can be used by third-party applications or devices to provide patients (or patient-authorized representatives) access to their health information, within 24 hours of its availability to the provider.
 
To calculate the percentage, CMS and ONC have worked together to define the following for this measure:
 
Measure Denominator: The number of unique patients seen by the EP or the number of unique patients discharged from an eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
 
Measure Numerator: The number of patients in the denominator who are provided access to information within 24 hours of its availability to the EP or eligible hospital/CAH.
 
Measure Threshold: The resulting percentage must be more than 80 percent in order for a provider to meet this measure.
 
Measure Exclusions: An EP may exclude from the measure if they have no office visits during the EHR reporting period. Any EP that conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude the measure. Any eligible hospital or CAH will be excluded from the measure if it is located in a county that does not have 50 percent or more of their housing units with 4Mbps broadband availability according to the latest information available from the FCC at the start of the EHR reporting period.
 
Proposed Measure 1:  Alternate Proposals for discussion
These three alternate proposals would represent different use cases for the CEHRT function to support view, download, and transmit and/or API functionality. They note that under these proposed alternates the following mix of functions would be applicable:
  • Alternate A would require both functions to be available instead of allowing the provider to choose between the two.
  • Alternate B would require the provider to choose to have either both functions, or just an API function.
  • Alternate C would require the provider to only have the API function. For Alternate C, the use of a separate view, download, and transmit function would be entirely at the provider's discretion and not included as part of the definition of meaningful use.
 
Proposed Measure 2: The EP, eligible hospital or CAH must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide electronic access to those materials to more than 35 percent of unique patients seen by the EP or discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
 
To calculate the percentage, CMS and ONC have worked together to define the following for this measure:
 
Measure Denominator: The number of unique patients seen by the EP or the number of unique patients discharged from an eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
 
Measure Numerator: The number of patients in the denominator who were provided electronic access to patient-specific educational resources using clinically relevant information identified from CEHRT.
 
Measure Threshold: The resulting percentage must be more than 35 percent in order for a provider to meet this measure.
 
Measure Exclusions: An EP may exclude from the measure if they have no office visits during the EHR reporting period. Any EP that conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude the measure. Any eligible hospital or CAH will be excluded from the measure if it is located in a county that does not have 50 percent or more of their housing units with 4Mbps broadband availability according to the latest information available from the FCC at the start of the EHR reporting period.
 

Objective 6: Coordination of Care through Patient Engagement (page 103)

Use communications functions of certified EHR technology to engage with patients or their authorized representatives about the patient's care.
 
Proposed Measures: We are proposing that providers must attest to the numerator and denominator for all three measures, but would only be required to successfully meet the threshold for two of the three proposed measures to meet the Coordination of Care through Patient Engagement Objective.
 
Proposed Measure 1: During the EHR reporting period, more than 25 percent of all unique patients seen by the EP or discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) actively engage with the electronic health record made accessible by the provider. An EP, eligible hospital or CAH may meet the measure by either:
  1. More than 25 percent of all unique patients (or patient-authorized representatives) seen by the EP or discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period view, download or transmit to a third party their health information; or
  2. More than 25 percent of all unique patients (or patient-authorized representatives) seen by the EP or discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period access their health information through the use of an ONC-certified API that can be used by third-party applications or devices.
 
To calculate the percentage, CMS and ONC have worked together to define the following for this measure:
 
Measure 1 Option 1: View, Download, or Transmit to a Third Party
 
Measure Denominator: Number of unique patients seen by the EP, or the number of unique patients discharged from an eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
 
Measure Numerator: The number of unique patients (or their authorized representatives) in the denominator who have viewed online, downloaded, or transmitted to a third party the patient's health information.
 
Measure Threshold: The resulting percentage must be more than 25 percent in order for an
EP, eligible hospital, or CAH to meet this measure.
 
Measure 1 Option 2: API
 
Measure Denominator: The number of unique patients seen by the EP or the number of unique patients discharged from an eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
 
Measure Numerator: The number of unique patients (or their authorized representatives) in the denominator who have accessed their health information through the use of an ONC-certified API.
 
Measure Threshold: The resulting percentage must be more than 25 percent in order for an EP, eligible hospital, or CAH to meet this measure.
 
Measure Exclusions: Applicable for either option discussed previously, the following providers may exclude from the measure: Any EP who has no office visits during the EHR reporting period may exclude from the measure. Any EP that conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude from the measure. Any eligible hospital or CAH operating in a location that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude from the measure.
 
Proposed Measure 2: For more than 35 percent of all unique patients seen by the EP or discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient's authorized representatives), or in response to a secure message sent by the patient (or the patient's authorized representative).
 
To calculate the percentage, CMS and ONC have worked together to define the following for this measure:
 
Measure Denominator: Number of unique patients seen by the EP or the number of unique patients discharged from an eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
 
Measure Numerator: The number of patients in the denominator for whom a secure electronic message is sent to the patient, the patient's authorized representatives, or in response to a secure message sent by the patient.
 
Measure Threshold: The resulting percentage must be more than 35 percent in order for an EP, eligible hospital, or CAH to meet this measure.
 
Measure Exclusion: Any EP who has no office visits during the EHR reporting period may exclude from the measure. Any EP that conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude from the measure. Any eligible hospital or CAH operating in a location that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude from the measure.
 
Proposed Measure 3: Patient-generated health data or data from a non-clinical setting is incorporated into the certified EHR technology for more than 15 percent of all unique patients seen by the EP or discharged by the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
 
To calculate the percentage, CMS and ONC have worked together to define the following for this measure:
 
Measure Denominator: Number of unique patients seen by the EP or the number of unique patients discharged from an eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
 
Measure Numerator: The number of patients in the denominator for whom data from non-clinical settings, which may include patient-generated health data, is captured through the certified EHR technology into the patient record.
 
Measure Threshold: The resulting percentage must be more than 15 percent in order for an EP, eligible hospital, or CAH to meet this measure.
 
Measure Exclusion: Any EP who has no office visits during the EHR reporting period may exclude from the measure. Any EP that conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude from the measure. Any eligible hospital or CAH operating in a location that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude from the measure.
 

Objective 7: Health Information Exchange (page 116)

The EP, eligible hospital, or CAH provides a summary of care record when transitioning or referring their patient to another setting of care, retrieves a summary of care record upon the first patient encounter with a new patient, and incorporates summary of care information from other providers into their EHR using the functions of certified EHR technology.
 
Proposed Measures: We are proposing that providers must attest to the numerator and denominator for all three measures, but would only be required to successfully meet the threshold for two of the three proposed measures to meet the Health Information Exchange Objective.
 
Proposed Measure 1: For more than 50 percent of transitions of care and referrals, the EP, eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care: (1) creates a summary of care record using CEHRT; and (2) electronically exchanges the summary of care record.
 
To calculate the percentage of the first measure, CMS and ONC have worked together to define the following for this measure:
 
Measure Denominator: Number of transitions of care and referrals during the EHR reporting period for which the EP or eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) was the transferring or referring provider.
 
Measure Numerator: The number of transitions of care and referrals in the denominator where a summary of care record was created using certified EHR technology and exchanged electronically.
Threshold: The percentage must be more than 50 percent in order for an EP, eligible hospital, or CAH to meet this measure.
 
Measure Exclusion: An EP neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period.  Any EP that conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude the measures. Any eligible hospital or CAH will be excluded from the measure if it is located in a county that does not have 50 percent or more of their housing units with 4Mbps broadband availability according to the latest information available from the FCC at the start of the EHR reporting period.
 
 
Proposed Measure 2: For more than 40 percent of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the EP, eligible hospital or CAH incorporates into the patient's EHR an electronic summary of care document from a source other than the provider's EHR system.
 
To calculate the percentage of the second measure, CMS and ONC have worked together to define the following for this measure:
 
Measure Denominator: Number of patient encounters during the EHR reporting period for which an EP, eligible hospital, or CAH was the receiving party of a transition or referral or has never before encountered the patient and for which an electronic summary of care record is available.
 
Measure Numerator: Number of patient encounters in the denominator where an electronic summary of care record received is incorporated by the provider into the certified EHR technology.
Measure Threshold: The percentage must be more than 40 percent in order for an EP, eligible hospital, or CAH to meet this measure.
 
Measure Exclusion: Any EP, eligible hospital or CAH for whom the total of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, is fewer than 100 during the EHR reporting period is excluded from this measure.  Any EP that conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude the measures.  Any eligible hospital or CAH will be excluded from the measure if it is located in a county that does not have 50 percent or more of their housing units with 4Mbps broadband availability according to the latest information available from the FCC at the start of the EHR reporting period.
 
Proposed Measure 3: For more than 80 percent of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the EP, eligible hospital, or CAH performs a clinical information reconciliation. The provider must implement clinical information reconciliation for the following three clinical information sets:
  • Medication. Review of the patient's medication, including the name, dosage, frequency, and route of each medication.
  • Medication allergy. Review of the patient's known allergic medications.
  • Current Problem list. Review of the patient's current and active diagnoses.
 
To calculate the percentage, CMS and ONC have worked together to define the following for this measure:
 
Measure Denominator: Number of transitions of care or referrals during the EHR reporting period for which the EP or eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) was the recipient of the transition or referral or has never before encountered the patient.
 
Measure Numerator: The number of transitions of care or referrals in the denominator where the following three clinical information reconciliations were performed: medication list, medication allergy list, and current problem list.
 
Measure Threshold: The resulting percentage must be more than 80 percent in order for an
EP, eligible hospital, or CAH to meet this measure.
 
Measure Exclusion: Any EP, eligible hospital or CAH for whom the total of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, is fewer than 100 during the EHR reporting period is excluded from this measure. Any EP that conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude the measures.  Any eligible hospital or CAH will be excluded from the measure if it is located in a county that does not have 50 percent or more of their housing units with 4Mbps broadband availability according to the latest information available from the FCC at the start of the EHR reporting period.
 
 

Objective 8: Public Health and Clinical Data Registry Reporting (page 135)

The EP, eligible hospital, or CAH is in active engagement with a PHA or CDR to submit electronic public health data in a meaningful way using certified EHR technology, except where prohibited, and in accordance with applicable law and practice.
 
Active Engagement Option 1 – Completed Registration to Submit Data: The EP, eligible hospital, or CAH registered to submit data with the PHA or, where applicable, the CDR to which the information is being submitted; registration was completed within 60 days after the start of the EHR reporting period; and the EP, eligible hospital, or CAH is awaiting an invitation from the PHA or CDR to begin testing and validation.
 
Active Engagement Option 2 - Testing and Validation: The EP, eligible hospital, or CAH is in the process of testing and validation of the electronic submission of data.
 
Active Engagement Option 3 – Production: The EP, eligible hospital, or CAH has completed testing and validation of the electronic submission and is electronically submitting production data to the PHA or CDR.
 
Proposed Measures: We are proposing a total of six possible measures for this objective. EPs would be required to choose from measures 1 through 5, and would be required to successfully attest to any combination of three measures. Eligible hospitals and CAHs would be required to choose from measures one through six, and would be required to successfully attest to any combination of four measures.  The measure are as shown in the table below:

Measures for Objective 8
Measure Maximum Times Counted for EP Maximum Times Counted for Hospital
Measure 1 – Immunization Registry Reporting
1 1
Measure 2 – Syndromic Surveillance Reporting 1 1
Measure 3 - Case Reporting 1 1
Measure 4 - Public Health Registry Reporting 3 4
Measure 5 – Clinical Data Registry Reporting 3 4
Measure 6 – Electronic Reportable Laboratory Result Reporting N/A 1
 
Measure 1 – Immunization Registry Reporting: The EP, eligible hospital, or CAH is in active engagement with a public health agency to submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system (IIS).
 
Measure 2 – Syndromic Surveillance Reporting: The EP, eligible hospital, or CAH is in active engagement with a public health agency to submit syndromic surveillance data from a non-urgent care ambulatory setting for EPs, or an emergency or urgent care department for eligible hospitals and CAHs (POS 23).
 
Exclusion for EPs for Measure 2: Any EP meeting one or more of the following criteria may be excluded from the syndromic surveillance reporting measure if the EP: (1) does not treat or diagnose or directly treat any disease or condition associated with a syndromic surveillance system in their jurisdiction; (2) operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data from EPs in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or (3) operates in a jurisdiction where no public health agency has declared readiness to receive syndromic surveillance data from EPs at the start of the EHR reporting period.
 
Exclusion for eligible hospitals/CAHs for Measure 2: Any eligible hospital or CAH meeting one or more of the following criteria may be excluded from the syndromic surveillance reporting measure if the eligible hospital or CAH: (1) does not have an emergency or urgent care department; (2) operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data from eligible hospitals or CAHs in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or (3) operates in a jurisdiction where no public health agency has declared readiness to receive syndromic surveillance data from eligible hospitals or CAHs at the start of the EHR reporting period.
 
Measure 3 - Case Reporting: The EP, eligible hospital, or CAH is in active engagement with a public health agency to submit case reporting of reportable conditions.
 
Exclusion for Measure 3: Any EP, eligible hospital, or CAH meeting one or more of the following criteria may be excluded from the case reporting measure if the EP, eligible hospital, or CAH: (1) does not treat or diagnose any reportable diseases for which data is collected by their jurisdiction's reportable disease system during the EHR reporting period; (2) operates in a jurisdiction for which no public health agency is capable of receiving electronic case reporting data in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or (3) operates in a jurisdiction where no public health agency has declared readiness to receive electronic case reporting data at the start of the EHR reporting period.
 
Measure 4 - Public Health Registry Reporting: The EP, eligible hospital, or CAH is in active engagement with a public health agency to submit data to public health registries.
 
Exclusions for Measure 4: Any EP, eligible hospital, or CAH meeting at least one of the following criteria may be excluded from the public health registry reporting measure if the EP, eligible hospital, or CAH: (1) does not diagnose or directly treat any disease or condition associated with a public health registry in their jurisdiction during the EHR reporting period; (2) operates in a jurisdiction for which no public health agency is capable of accepting electronic registry transactions in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or (3) operates in a jurisdiction where no public health registry for which the EP, eligible hospital, or CAH is eligible has declared readiness to receive electronic registry transactions at the beginning of the EHR reporting period.
 
Measure 5 – Clinical Data Registry Reporting: The EP, eligible hospital, or CAH is in active engagement to submit data to a clinical data registry.
 
Exclusions for Measure 5: Any EP, eligible hospital, or CAH meeting at least one of the following criteria may be excluded from the clinical data registry reporting measure if the EP, eligible hospital, or CAH: (1) does not diagnose or directly treat any disease or condition associated with a clinical data registry in their jurisdiction during the EHR reporting period; (2) operates in a jurisdiction for which no clinical data registry is capable of accepting electronic registry transactions in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or (3) operates in a jurisdiction where no clinical data registry for which the EP, eligible hospital, or CAH is eligible has declared readiness to receive electronic registry transactions at the beginning of the EHR reporting period.
 
Measure 6 – Electronic Reportable Laboratory Result Reporting: The eligible hospital or CAH is in active engagement with a public health agency to submit electronic reportable laboratory results. This measure is available to eligible hospitals and CAHs only.
 
Exclusion for Measure 6: Any eligible hospital or CAH meeting one or more of the following criteria may be excluded from the electronic reportable laboratory result reporting measure if the eligible hospital or CAH: (1) does not perform or order laboratory tests that are reportable in their jurisdiction during the EHR reporting period;  (2) operates in a jurisdiction for which no public health agency is capable of accepting the specific ELR standards required to meet the CEHRT definition at the start of the EHR reporting period; or (3) operates in a jurisdiction where no public health agency has declared readiness to receive electronic reportable laboratory results from an eligible hospital or CAH at the start of the EHR reporting period.
 
CMS welcome public comment on these proposals.  
 
 
Posted: 3/22/2015 3:18:38 PM by Charlie Harp | with 0 comments