OpenEMR Certification Stage II Meaningful Use

Overview

This is the project page for the OpenEMR Certification Stage II Meaningful Use project, which is due before the last quarter in 2014. The goal is to have certification by mid 2014. There are 45 Certification Criteria, which are organized into 7 different topics (Clinical, Care Coordination, Clinical Quality Measures, Privacy and Security, Patient Engagement, Public Health, and Utilization).

Here are some useful links:

• HealthIT.gov Stage 2 Page
• Stage 2 CMS Final Rule
• Stage 2 ONC Final Rule
• pdf of final ONC rule: File:2014 Edition Cert Federal Register.pdf
• Stage 2 Final Test Methods (NIST/ONC)
• Very nice information by Visolve that describes the MU2 criteria:

• 'Meaningful Use Stage 2' slides
• 'Stage 2 Meaningful Use Final Rules' web page

• Ongoing MU2 work by ZH Healthcare, which will be included in OpenEMR:

• http://sourceforge.net/p/zhopenemr/wiki/Home/

Fund Raising

This barometer will track the funds available via the OEMR 501c3 that are dedicated to this goal

$1000

$5000

$10,000

$10,000

$15,000

$20,000

$25,000

<Cert Goal>

$30,000

$35,000

$40,000

$45,000

$50,000

$55,000

$60,000

$65,000

$70,000

$75,000

$80,000

$85,000

$90,000

$95,000

$100,000

Not Funded

Certification Test Cost

Development Funds

Legend Description:

• Not Funded - Unfunded Goal.
• Certification Test Cost - Funds Needed to pay for Certification Testing
• Development - Funds available for development work
• * notes There are funds pledged to date of $8000 and matching funds of up to 10% of the overall funding

Completion Barometer

This barometer will track the progress of the Stage 2 MU project. See below Certification Criteria section for criteria titles.

a1*

a2

a3

a4

a5

a6*

a7*

a8

a9

a10

a11

a12

a13

a14

a15

b1

b2

b3

b4

b5

b7

c1

c2

c3

d1*

d2

d3

d4

d5

d6*

d7

d8*

d9*

e1

e2

e3

f1*

f2

f3

f5

f6

g1

g2

g3

g4

Not Started

Analyzing In Progress

Analyzing Complete

Coding In Progress

Complete

Finalized

Third Party Pending

Legend Description:

• Not Started - Not yet analyzed.
• Analyzing In Progress - Analyzing for ONC/NIST guidelines
• Analyzing Complete - Finished analyzing for ONC/NIST guidelines
• Coding In Progress - Coding for ONC/NIST guidelines
• Complete - Complete according to ONC/NIST guidelines
• Finalized - Passes the certification testing scripts
• Third Party Pending - Planned to be completed by third party
• * notes Gap Eligible Criteria (Criteria categorized as "Unchanged" between 2011 and 2014 edition)

Certification Criteria

Definitions for terms used in the below Criteria wiki pages:

• Owner - This is the "current" person/group(s) that are working on this criteria and can be found in parenthesis next to the item.

Clinical (170.314(a))

a1. Computerized provider order entry (Finalized)

a2. Drug-drug, drug-allergy interaction checks (owner is NewCrop)

a3. Demographics (owner is Jan Jajalla)

a4. Vital signs, body mass index, and growth charts (No owner)

a5. Problem list (Finalized)

a6. Medication list (No owner)

a7. Medication allergy list (No owner)

a8. Clinical decision support (No owner)

a9. Electronic notes (Finalized)

a10. Drug-formulary checks (owner is ZH Healthcare)

a11. Smoking status (No owner)

a12. Image results (No owner)

a13. Family health history (No owner)

a14. Patient list creation (No owner)

a15. Patient-specific education resources (No owner)

Care Coordination (170.314(b))

b1. Transitions of care – receive, display, and incorporate transition of care/referral summaries (owner is ZH Healthcare)

b2. Transitions of care – create and transmit transition of care/referral summaries (owner is ZH Healthcare)

b3. Electronic prescribing (owner is ZH Healthcare)

b4. Clinical information reconciliation (owner is ZH Healthcare)

b5. Incorporate lab tests and values/results (owner is ZH Healthcare)

b7. Data portability (owner is ZH Healthcare)

Clinical Quality Measures (170.314(c))

c1. Clinical quality measures - capture and export (owner is ZH Healthcare)

c2. Clinical quality measures - import and calculate (owner is ZH Healthcare)

c3. Clinical quality measures - electronic submission (owner is ZH Healthcare)

Privacy and Security (170.314(d))

d1. Authentication, access control, and authorization (No owner)

d2. Auditable events and tamper-resistance (No owner)

d3. Audit report(s) (No owner)

d4. Amendments (No owner)

d5. Automatic log-off (Finalized)

d6. Emergency access (No owner)

d7. End-user device encryption (No owner)

d8. Integrity (No owner)

d9. Accounting of disclosures (No owner)

Patient Engagement (170.314(e))

e1. View, download, and transmit to 3rd party (owner is ZH Healthcare)

e2. Clinical summaries (owner is ZH Healthcare)

e3. Secure messaging (owner is ZH Healthcare)

Public Health (170.314(f))

f1. Immunization information (Finalized)

f2. Transmission to immunization registries (owner is ZH Healthcare)

f3. Transmission to public health agencies – syndromic surveillance (owner is ZH Healthcare)

f5. Cancer case information (owner is ZH Healthcare)

f6. Transmission to cancer registries (owner is ZH Healthcare)

Utilization (170.314(g))

g1. Automated numerator recording (No owner)

g2. Automated measure calculation (No owner)

g3. Safety-enhanced design (No owner)

g4. Quality management system (No owner)

Features that Are Needed (ie. "Building Blocks")

• Prescriptions/meds/allergies need to have a RxNorm association option.
• Production and real incorporation of fully-featured CCD and CCD(a)s at some point. (ZH is working on this)
• Be able to connect to DIRECT. Here is home page of Direct: http://www.healthit.gov/policy-researchers-implementers/direct-project (EMR Direct provided a solution for this which has been committed into OpenEMR 4.1.2: Direct)
• Medical problems need to have a SNOMED association option (Already supported since 4.1.1 version)

• Need to support import of US SNOMED extension package in addition to the currently supported base international package (ie. need to be able to install/update both simultaneously). (This feature was committed to OpenEMR 4.1.2)

Estimates

• Here is a estimate by Visolve of the time to complete each certification criteria above. The estimate is approximately 80 work weeks of effort.

• File:OpenEMR MUO Stage2 Estimation.pdf

Notes

Some Analysis of Proposed Guidelines (Outdated)

Difference(s) from Stage 1

Improving quality, safety, efficiency, and reducing health disparities

Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter licensed healthcare professional who can enter orders into the medical record per State, local and professional guidelines to create the first record of the order.

More than 60 percent of medication, laboratory, and radiology 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 CPOE.

• Adds laboratory & radiology
• Increased from 30% to 60%
• Requirement is based on number of orders, not number of patients.

Generate and transmit permissible prescriptions electronically (eRx)

More than 65 percent of all permissible prescriptions written by the EP are compared to at least one drug formulary and transmitted electronically using Certified EHR Technology.

• Increased from 40% to 65%.
• Includes formulary check which formerly was part of menu set

Record the following demographics

• Preferred language
• Gender
• Race
• Ethnicity
• Date of birth

More than 80 percent of all unique patients seen by the EP have demographics recorded as structured data

• Increased from 50% to 80%.

Record and chart changes in vital signs:

• Height/length
• Weight
• Blood pressure (age 3 and over)
• Calculate and display BMI
• Plot and display growth charts for patients 0-20 years, including BMI

More than 80 percent of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and height/length and weight (for all ages) recorded as structured data

• Increased from 50% to 80%.
• Changed from age 2 and over to age 3 and over.

Record smoking status for patients 13 years old or older More than 80% of all unique patients 13 years old or older seen by the have smoking status recorded as structured data

• Increased from 50% to 80%.

Use clinical decision support to improve performance on high-priority health conditions

1. Implement 5 clinical decision support interventions related to 5 or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period.
2. The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entre EHR reporting period.

• Increased from implementing one rule to five.
• Must be related to five quality measures for entire reporting period.
• Incorporates drug-drug/drug-allergy checks (formerly standalone requirement).

Incorporate clinical lab-test results into Certified EHR Technology as structured data

More than 55 percent of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in Certified EHR Technology as structured data

• Formerly menu set item.
• Increased from 40% to 55%.

Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach

Generate at least one report listing patients of the EP, eligible hospital or CAH with a specific condition.

• Formerly menu set item.

Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care

More than 10 percent of all unique patients who have had an office visit with the EP within the 24 months prior to the beginning of the EHR reporting period were sent a reminder, per patient preference

• Formerly menu set item.
• Eliminated age parameters; changed to “unique patients who have had an office visit”

Engage patients and families in their health care

Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP.

1. More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information subject to the EP's discretion to withhold certain information
2. More than 10 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download , or transmit to a third party their health information

• Formerly menu set item.
• More specific
• Increased from 10% to 50%
• Added requirement for patients to “view, download or transmit” information.