OpenEMR Certification Stage III Meaningful Use
From OpenEMR Project Wiki
Overview
- Successfully completed testing on 6/30/22 and final certification was completed on 7/8/22. Released OpenEMR 7.0.0, which is ONC certified on 7/19/22. See the blog article on this monumental feat at: OpenEMR Achieves ONC Certification with Groundbreaking Release 7.0
- Testing body is SLI.
- Links:
- https://www.healthit.gov/topic/certification-ehrs/2015-edition
- https://qpp.cms.gov/mips/overview
- https://build.fhir.org/ig/HL7/US-Core/general-guidance.html
- https://www.healthit.gov/isa/sites/isa/files/2020-07/USCDI-Version-1-July-2020-Errata-Final.pdf
- https://build.fhir.org/ig/HL7/US-Core-R4/general-guidance.html#us-core-data-for-interoperability-and-2015-edition-common-clinical-data-set
- https://www.healthit.gov/sites/default/files/topiclanding/2018-04/2015Ed_CCG_CCDS.pdf
- https://inferno.healthit.gov/inferno
- https://inferno.healthit.gov/inferno/f3X6ykpeyzv/test_sets/test_procedure/
Forums and Discussion
Funding and Sponsors
Barometer
Required to Pay for Testing and Certification - $16,125
$5,000 | $10,000 | $13,125 | $16,000 | $16,125 |
$5,000 | $10,000 | $13,125 | $16,000 | $16,125 |
Required to support development efforts and timely delivery - $116,000
$10,000 | $20,000 | $30,000 | $40,000 | $50,000 | $60,000 | $70,000 | $80,000 | $90,000 | $97,600 | $100,000 | $110,000 | $113,709 | $116,000 |
$10,000 | $20,000 | $30,000 | $40,000 | $50,000 | $60,000 | $70,000 | $80,000 | $90,000 | $97,600 | $100,000 | $110,000 | $113,709 |
- Legend Description:
- Funds Raised - Funds raised.
- Not Funded - Unfunded Goal.
- Expended Funds - Funds that have been spent.
- Funds Contracted Out - Funds that have been contracted out.
Fund Drive for ONC Certification
- Help OpenEMR obtain Certification by donating here.
For lower processing fees please email hello@open-emr.org for wire transfer instructions.
Major sponsors
- Care Management Solutions, https://cmsvt.org
- Community Behavioral Health, https://www.communitybehavioralhealth.net
- Dr. Niru Jani
- Dr. Sushma Jani
- Michael J. Blaho, https://www.synergyinfoconnect.com/
- Brent Boecking, https://procaremedcenter.com/
- Comlink, http://www.comlinkinc.com, Amit Panjwani, CEO
- Oak Street Health, https://www.oakstreethealth.com/
Completion Barometer
- This barometer is tracking the progress of the ONC Certification (ie. Stage 3 MU) project. See below Certification Criteria section for criteria titles and further details on progress tracking.
- The below items were chosen as the minimum to support ONC certification with CEHRT (although note CEHRT is dependent on CMS).
a1* | a2* | a5* | a9* | a12* | a14* | b1 | b10 | c1* | c2* | c3* | d1* | d2* | d3* | d4* | d5* | d6* | d7* | d8* | d9* | d12* | d13* | e3* | g2* | g3* | g4 | g5 | g6 | g7* | g9 | g10 | h1 |
- Legend Description:
- Not Yet Analyzed - Has not been analyzed yet.
- Not Ready - Not ready for certification testing and waiting for somebody to work on this.
- Not Ready (actively working on) - Not ready for certification testing, but are actively working on this.
- Ready - Ready for certification testing. ( F means is Finalized (has been checked thoroughly and has an associated wiki page detailing why it is ready) and officially ready ready to self-declare or test.)
- Failed Test - Issues found during certification testing.
- Certification Pass - Passed certification and in official codebase.
- * - Self-declaration (this involves self-declaration rather than formal testing with the testing body).
Certification Criteria Reference and Tracking
- Owner(s) - This is the "current" person/group(s) that are working on the criteria (or building block) and can be found in parenthesis next to the item.
- Building Blocks:
- CQM
- CCDA
- FHIR
- API
- OAuth
- SMART
- FINALIZED means items is finalized (has been checked thoroughly and has an associated wiki page detailing why it is ready) and is ready to self-declare or test.
Clinical (170.315(a))
- a1. Computerized provider order entry (CPOE) – medications (forum | wiki): FINALIZED
- a2. CPOE – laboratory (forum | wiki): FINALIZED
- a3. CPOE – diagnostic imaging (forum | wiki):
- a4. Drug-drug, drug-allergy interaction checks for CPOE (forum | wiki):
- a5. Demographics (forum | wiki): FINALIZED
- a6. Problem list (forum | wiki):
- a7. Medication list (forum | wiki):
- a8. Medication allergy list (forum | wiki):
- a9. Clinical decision support (forum | wiki): FINALIZED
- a10. Drug-formulary and preferred drug list checks (forum | wiki):
- a11. Smoking status (forum | wiki):
- a12. Family health history (forum | wiki): FINALIZED
- a13. Patient-specific education resources (forum | wiki):
- a14. Implantable device list (forum | wiki): FINALIZED
- a15. Social, psychological, and behavioral data (forum | wiki):
Care Coordination (170.315(b))
- b1. Transitions of care (forum | wiki): CCDA FINALIZED
- b2. Clinical information reconciliation and incorporation (forum | wiki):
- b3. Electronic prescribing (forum | wiki):
- b4. Common Clinical Data Set summary record – create (forum | wiki):
- b5. Common Clinical Data Set summary record – receive (forum | wiki):
- b6. Data export (forum | wiki):
- b7. Data segmentation for privacy – send (forum | wiki):
- b8. Data segmentation for privacy – receive (forum | wiki):
- b9. Care plan (forum | wiki):
- b10. Electronic health information (EHI) export (forum | wiki): FINALIZED
- b11. Electronic prescribing (forum | wiki):
- b12. Data segmentation for privacy – send (forum | wiki):
- b13. Data segmentation for privacy – receive (forum | wiki):
Clinical Quality Measures (170.315(c))
- List of eCQMs undergoing certification
- Management of Chronic Conditions
- CMS122v10 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) (EP)
- CMS165v10 Controlling High Blood Pressure (EP)
- Prevention and Treatment of Opioid and Substance Use Disorders
- CMS138v10 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (EP)
- Preventive Care
- CMS22v10 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented (EP)
- CMS69v10 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan (EP)
- CMS124v10 Cervical Cancer Screening (EP)
- CMS125v10 Breast Cancer Screening (EP)
- CMS127v10 Pneumococcal Vaccination Status for Older Adults (EP)
- CMS130v10 Colorectal Cancer Screening (EP)
- CMS147v11 Preventive Care and Screening: Influenza Immunization (EP)
-
- v12 went into effect for 2023 reporting, https://ecqi.healthit.gov/sites/default/files/EC-MeasuresTable-2022-05-v3.pdf
- this measure is retired in 2024
- c2. CQMs – import and calculate (forum | wiki): CQM FINALIZED
- c3. CQMs – report criterion (forum | wiki): CQM FINALIZED
- c4. CQMs – filter (forum | wiki):
Privacy and Security (170.315(d))
- d1. Authentication, access control, and authorization (forum | wiki): FINALIZED
- d2. Auditable events and tamper-resistance (forum | wiki): (estimated work to complete: low/moderate) FINALIZED
- d3. Audit report(s) (forum | wiki): FINALIZED
- d4. Amendments (forum | wiki): FINALIZED
- d5. Automatic access time-out (forum | wiki): FINALIZED
- d6. Emergency access (forum | wiki): FINALIZED
- d7. End-user device encryption (forum | wiki): FINALIZED
- d8. Integrity (forum | wiki): FINALIZED
- d9. Trusted connection (forum | wiki): FINALIZED
- d10. Auditing actions on health information (forum | wiki):
- d11. Accounting of disclosures (forum | wiki):
- d12. Encrypt authentication credentials certification criterion (forum | wiki): FINALIZED
- d13. Multi-factor authentication (MFA) criterion (forum | wiki): FINALIZED
Patient Engagement (170.315(e))
- e1. View, download, and transmit to 3rd party (forum | wiki):
- e2. Secure messaging (forum | wiki):
- e3. Patient health information capture (forum | wiki): FINALIZED
Public Health (170.315(f))
- f1. Transmission to immunization registries (forum | wiki):
- f2. Transmission to public health agencies – syndromic surveillance (forum | wiki):
- f3. Transmission to public health agencies – reportable laboratory tests and value/results (forum | wiki):
- f4. Transmission to cancer registries (forum | wiki):
- f5. Transmission to public health agencies – electronic case reporting (forum | wiki):
- f6. Transmission to public health agencies – antimicrobial use and resistance reporting (forum | wiki):
- f7. Transmission to public health agencies – health care surveys (forum | wiki):
Utilization (170.315(g))
- g1. Automated numerator recording (forum | wiki):
- g2. Automated measure calculation (forum | wiki): FINALIZED
- g3. Safety-enhanced design (forum | wiki): FINALIZED
- g4. Quality management system (forum | wiki): FINALIZED
- g5. Accessibility-centered design (forum | wiki): FINALIZED
- g6. Consolidated CDA creation performance (forum | wiki): CCDA This will automatically pass when b1 passes, so is FINALIZED
- g7. Application access – patient selection (forum | wiki): API FHIR FINALIZED
- g8. Application access – data category request (forum | wiki):
- g9. Application access – all data request (forum | wiki): API CCDA FINALIZED
- g10. Standardized API for patient and population services (forum | wiki): OAuth SMART FHIR FINALIZED
- g11. Consent management for application programming interfaces (forum | wiki):
Transport methods and other protocols (170.315(h))
- h1. Direct Project (forum | wiki): (estimated work to complete: low/moderate) FINALIZED
- h2. Direct Project, Edge Protocol, and XDR/XDM (forum | wiki):
Instance Specific Requirements Tracking
- This will track the settings that a instance needs to use to fulfill ONC Certification. These instructions will go into the install/upgrade instruction sets.
- You are required to register your Organization name and FHIR endpoint with the OpenEMR Foundation by sending an email with this information to hello@open-emr.org with subject of 'ONC Certification registration'. This information will be posted on OpenEMR_7.0.0_API#Service_Base_URLs, which is a requirement for ONC Certification(the OpenEMR Foundation is required to post this information within 10 days of your request).
- Required global settings
- Administration->Globals->Security->Hash Algorithm for Authentication->SHA512 (ONC Certification)
- Administration->Globals->Security->Hash Algorithm for Token->SHA512 (ONC Certification)
- Administration->Globals->Logging->Enable Audit Log Encryption->On
- Administration->Globals->Connectors->Enable OpenEMR Standard FHIR REST API->On
- To ensure optimal security, users are required to run their OpenEMR client web browser on a end-user device that encrypts entire drive(s) with AES based encryption algorithm.
- To ensure optimal security, users are required to use a FIPS compliant cipher for the HTTPS/SSL browser connection.
- To ensure accurate time, server are required to set up a Network Time Protocol server that supports version 4 Network Time Protocol (NTP) as defined by RFC 5905.
- For users NOT NEEDING ONC Certification, then would consider setting following global setting to improve performance
- Administration->Globals->Security->Audit Logging SELECT Query->Off
- Administration->Globals->Security->Printing Log Option->No logging
Acknowledgment Tracking
ONC Certification Project Managers
- Brady Miller
- Jerry Padgett
- Stephen Nielson
- Stephen Waite
Contributors
- Arnab Naha
- Brady Miller* - CCDA, FHIR, API, OAuth, Demographics, Clinical decision support, Implantable device list, Family health history, Auditable events and tamper-resistance, Audit report(s), Integrity, Encrypt authentication credentials certification criterion, Patient health information capture, Safety-enhanced design, Application access – patient selection
- Brent Boecking
- Care Management Solutions
- Columbia University HIT Program - Safety-enhanced design
- Comlink
- Community Behavioral Health
- David Eschelbacher
- David Zhang
- EMR Direct
- Jerry Padgett* - CCDA, FHIR, API, OAuth, CQM, Clinical quality measures (CQMs) – record and export, CQMs – import and calculate, CQMs – report criterion, Transitions of care, Application access – all data request, Standardized API for patient and population services
- Jocelyn Valenzuela
- Katy Dovgala
- Ken Chapple - CQM, Clinical quality measures (CQMs) – record and export, CQMs – import and calculate, CQMs – report criterion
- Kenn Vincent Kongyingyong
- Kenneth Newman
- Lawrence Lo
- Mariam Mohsin
- Michael J. Blaho
- Niru Jani
- Oak Street Health
- OpenEMR Foundation
- Paul Montenegro
- Rachel Ellison - Implantable device list
- Salina Chan
- Samta Jain
- Sandra Gutierrez
- Sherron Andrews
- Stephen Nielson* - SMART, FHIR, API, OAuth, CQM, Transitions of care, Clinical quality measures (CQMs) – record and export, CQMs – import and calculate, CQMs – report criterion, Automated measure calculation, Application access – patient selection, Application access – all data request, Standardized API for patient and population services, Direct Project
- Stephen Waite* - Quality management system, Clinical quality measures (CQMs) – record and export
- Sushma Jani
- Tamara Brantley
- Theresa Haywood
- Thuyet Tran - Demographics
- Tiffany Fludd
- Vikram Reddy
- Virginia Lorenzi
- Vishnu Yarmaneni - FHIR
- Willy Liu
- Yash Raj Bothra - FHIR
Notes
- Below is how we derived the items to include in the main barometer:
- Based on analysis incorporating finalized proposed changes and onc certified: drop a6, a7, a8, a11, b4, b5; revise b1, b2, b3, b7, b8, b9, c3, d2, d3, d10, e1, f5, g6, g9; new b10, d12, d13, g10.(note goal is to only list the required items)
- Note the following OR items: a2 or a3, g1 or g2, h1 or h2
- EXTRAPOLATED EHR gap items are a1, a2 or a3. EHR non-gap items are a5, a9, a14, b1, b6, c1, g7, g8, g9, h1 or h2.
- EXTRAPOLATED Bonus items need for MIPS are a12, e3, g1 or g2, c2, c3, (c4 is optional).
- Above 2 lists distill to a1, a2 or a3, a5, a9, a12, a14, b1, b6, c1, c2, c3, e3, g1 or g2, g7, g8, g9, h1 or h2
- onc certified specific items are: a1, a2 or a3, a5, a9, a14, b1(standard or onc certified(onc certified is mandatory after 5/2/22)), c1, g7, g8 or g10(g10 is mandatory after 5/2/22), g9(standard or onc certified(onc certified is mandatory after 5/2/22)), h1 or h2
- New distilled list including onc certified stuff that is mandatory after 5/22/22: a1, a2 or a3, a5, a9, a12, a14, b1(onc certified version), b6, c1, c2, c3, e3, g1 or g2, g7, g9(onc certified version), g10(onc certified), h1 or h2
- Dependency items also needed are b10, d1-d9, d12, d13, g3-g6(g6 is considered completed when b1 and b6 is completed)
- Final listing (above 2 lists combined): a1, a2 or a3(will do a2), a5, a9, a12, a14, b1(onc certified version), b6, b10, c1, c2, c3, d1-d9, d12, d13, e3, g1 or g2(will do g2), g3-g6(g6 is considered completed when b1 and b6 is completed), g7, g9(onc certified version), g10(onc certified), h1 or h2(will do h1)
- Final adjustment after discussion with testing body: e3 not needed, g8 is needed, no more gap certification eligibility
- The real Final listing (above 2 lists integrated): a1, a2 or a3(will do a2), a5, a9, a12, a14, b1(onc certified version), b6, b10, c1, c2, c3, d1-d9, d12, d13, g1 or g2(will do g2), g3-g6(g6 is considered completed when b1 and b6 is completed), g7, g8, g9(onc certified version), g10(onc certified), h1 or h2(will do h1)
- Since doing onc certified.
- Complete b10, so can drop b6.
- Complete g10, so can drop g8.
- Research if following items are not part of BASE (ie. are they required for CEHRT and MIPS and onc certified): a12, b10, c2, c3, g2
Redo analysis from scratch (to ensure on right path)
- Base EHR definition for onc certified Update (https://www.healthit.gov/topic/certification-ehrs/2015-edition-test-method/2015-edition-onc certified-update-base-electronic-health-record-definition)
- a1, a2 or a3, a5, a9, a14, b1, c1, g7, g9, g10, h1 or h2
- Dependencies for above items:
- d1, d2, d3, d4, d5, d6, d7, d8, d9, d12, d13, g3, g4, g5, g6
- Note above items are determined by ONC for Base EHR. Also need to ensure get CEHRT status which is determined by CMS and appears more confusing to sort out (analysis ongoing): https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Certification
- Additional items required for CEHRT (ongoing analysis):
- Per https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-495/subpart-A/section-495.4 need:
- a12, e3, c2, c3, (g1 or g2)
- Items that can drop:
- b10
- Items that plan to add on first cert:
- e3
- Items that plan to add on second cert (per SN analysis):
- a3 (not clear and plan d/w SN), a10, a13, b2, b3, e1 (was gonna do this on first round, but looks like significant work may be involved), e2 (not clear and plan d/w SN),