OpenEMR Certification Stage II Meaningful Use

From OpenEMR Project Wiki

Overview

This is the project page for the OpenEMR Certification Stage II Meaningful Use project. Modular Certification was obtained on December 24,2014 (for OpenEMR 4.2.x which was released on 12/28/14). The goal is to have Full Certification as soon as possible. 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:
  • Ongoing MU2 work by ZH Healthcare, which will be included in OpenEMR:


Fund Raising

This barometer will track the approximate funds available via the OEMR 501c3 that are dedicated to this goal
Not Funded Certification Test Funds Development Funds Expended Funds

Required to Pay for Testing and Certification

$1000 $5000 $10,000 $15,000 $20,000 $25,000

GOAL ACHIEVED! --Tony McCormick 22:27, 29 January 2014 (UTC)

Required to support development efforts and timely delivery

$2,500 $5,000 $10,000 $12,500 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 $55,000 $60,000 $65,000 $70,000 $75,000


Legend Description:
  • Not Funded - Unfunded Goal.
  • Certification Test Cost - Funds available to pay for Certification Testing
  • Development - Funds available for development work



Matching Fund Drive for OpenEMR MU2 Certification

Care Management Solutions, Inc. was pleased to donate $2,210 in matching funds on 2015-12-31. Please continue to help OpenEMR obtain Meaningful Use 2 Certification!!


DONATE HERE


$250 $500 $1000 $1500 $2,000 $2,210 $3,000 $3,500 $4,000 $4,500 $5,000 MATCHING GOAL $10,000


DONATE HERE


Completion Barometer

  • Modular Certification was obtained on December 24,2014 (for OpenEMR 4.2.x which was released on 12/28/14).
  • The goal is to have Full Certification as soon as possible
  • The last certification testing date was on 9/1/16. Next testing dates are on 10/17/16 and 10/18/16.
  • This barometer is tracking 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 g2 g3 g4


Legend Description:
  • Not Ready - Not ready for certification testing.
  • Ready - Ready for certification testing.
  • Failed Test - Issues found during certification testing.
  • Certification Pass - Passed certification, but not yet in official codebase.
  • Certification Pass - Passed certification and in official codebase.
  • Technical Review Issues - Initially passed certification and in official codebase, however with issues on the final Technical Review.



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 - Visolve)
a2. Drug-drug, drug-allergy interaction checks (Finalized - MI-Squared/NewCrop)
a3. Demographics (Finalized - Jan Jajalla and Visolve)
a4. Vital signs, body mass index, and growth charts (Finalized - Jan Jajalla)
a5. Problem list (Finalized - ZH Healthcare and Visolve)
a6. Medication list (Finalized)
a7. Medication allergy list (Finalized)
a8. Clinical decision support (Finalized - EnSoftek and Visolve and MI-Squared and Brady Miller)
a9. Electronic notes (Finalized - ZH Healthcare)
a10. Drug-formulary checks (Finalized - MI-Squared/ZH Healthcare Via NewCrop)
a11. Smoking status (Finalized - Brady Miller and Ensoftek)
a12. Image results (Owner - Ensoftek and Visolve) (Requirement was not test new requirements. Must be retest to show indication and access of images.)
a13. Family health history (Finalized - Ensoftek)
a14. Patient list creation (Finalized - Ensoftek and Visolve)
a15. Patient-specific education resources (Finalized - Sunset Systems)

Care Coordination (170.314(b))

b1. Transitions of care – receive, display, and incorporate transition of care/referral summaries Finalized - ZH Healthcare)
b2. Transitions of care – create and transmit transition of care/referral summaries (Owner - ZH Healthcare) (XML provided are not passing validation and missing required coded sections. I.e. reactions for allergies. Please check all required MU section in the XMLs.)
b3. Electronic prescribing (Finalized - MI-Squared/Ensoftek)
b4. Clinical information reconciliation (Finalized - ZH Healthcare)
b5. Incorporate lab tests and values/results (Finalized - Sunset Systems and MI-Squared)
b7. Data portability (Owner - ZH Healthcare) (Issues with human readable results. The patient used is not matching the test data used. XML are not passing tool validation. Need to fix all issues and insure all MU coded section are included in XML sections.)

Clinical Quality Measures (170.314(c))

c1. Clinical quality measures - capture and export (Finalized - Ensoftek and Visolve)
c2. Clinical quality measures - import and calculate (Finalized - Ensoftek and Visolve)
c3. Clinical quality measures - electronic submission (Finalized - Ensoftek and Visolve)

Privacy and Security (170.314(d))

d1. Authentication, access control, and authorization (Finalized)
d2. Auditable events and tamper-resistance (Owner - Ensoftek, MI-Squared, Sunset Systems, and Visolve) (Need to understand table Id for assement.)
d3. Audit report(s) (Owner - Ensoftek and Visolve) (Need to view sorting by what was accessed not just comments. The follow step is not proven "Using the Vendor-provided audit log or report, sort the audit log information according to identification of the patient data that is accessed ")
d4. Amendments (Finalized - Ensoftek)
d5. Automatic log-off (Finalized)
d6. Emergency access (Finalized)
d7. End-user device encryption (Finalized)
d8. Integrity (Owner - Visolve) (We do not have the evidence of message digiest exchange.)
d9. Accounting of disclosures (Finalized - Ensoftek)

Patient Engagement (170.314(e))

e1. View, download, and transmit to 3rd party (Owner - ZH Healthcare) (Issues with human readable results. The patient used is not matching the test data used. XML are not passing tool validation. Need to fix all issues and insure all MU coded section are included in XML sections. Also, the WCAG report is missing the following Where is web page accessible version/pure decoration, which features not verified by tool, and what was achecker used to check? Potential problems do not have rationale justifying failures.)
e2. Clinical summaries (Owner - ZH Healthcare) (This was not tested correctly. Will need to test again and same issues with XMLs as above.)
e3. Secure messaging (Finalized - ZH Healthcare)

Public Health (170.314(f))

f1. Immunization information (Finalized - Jan Jajalla)
f2. Transmission to immunization registries (Finalized - ZH Healthcare)
f3. Transmission to public health agencies – syndromic surveillance (Finalized - ZH Healthcare. There are two solutions. ZH Healthcare solution is certified and in codebase. Ensoftek solution is in codebase but not yet certified.)
f5. Cancer case information (Optional and not needed for certification)
f6. Transmission to cancer registries (Optional and not needed for certification)

Utilization (170.314(g))

g2. Automated measure calculation (Finalized - Ensoftek and ZH Healthcare and MI-Squared and Visolve and Brady Miller)
g3. Safety-enhanced design (Owner - Visolve and Brady Miller and Columbia University Health IT Certificate Program and MI-Squared and ZH Healthcare) (Please see attached document "openemr review" Red indicates corrections needed.) The revised G3 usability report was emailed on 9/26/16.
g4. Quality management system (Finalized)


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

  • Prescriptions/meds/allergies need to have a RxNorm association option. (Rod added support for this in 4.2.0)
  • Production and real incorporation of fully-featured CCD and CCD(a)s. (ZH completed this and is in OpenEMR 4.2.1)
  • 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 was 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

  • 4/22/16 by Visolve on items a8, c1-3, and g2.
  • Gap Analysis.
  • Time estimate to complete and certify items.
  • Development: 6 to 7 Engineering weeks
  • Testing: 1 week
  • Reasoning for estimate:
  • CQM: Out of 9 measures, only 6 are available and those 6 have 400 errors. This requires analysis of the current code, code adjustment to fix the errors, and the incorporation of 3 additional measures into the report.
  • Clinical Decision Support: Need to work on the Lab results rule. Need to validate the CCDA and Lab results incorporation. Given that it also deals with Newcrop, need to verify the diagnostic and therapeutic link for drug-drug, drug-allergy interaction, and need to confirm that it is currently available with Newcrop.
  • Automated Measures Calculation: Based on Gap Analysis, still with 3 rules that need to be written, and with 2 rules failing. Moreover, have included the effort for validating 6 other rules in the estimate, which couldn't do in the gap analysis because they have dependencies on the Care Coordination module, Newcrop, offsite portal, and the lab module which will require resources to provide.
  • Cost to complete and certify items.
  • Standard rate would be $7000
  • Agreed to discounted rate of $3900, which was officially sponsored by OEMR organization on 4/27/2016.
  • Ongoing Updates
  • 5/12/2016
  • Testing demo almost completed (Newcrop, Care Coordination Module, and CCDA are working; still working on the offsite Patient Portal).
  • CQM 2011 Hypertension rule added to 2014 rules as a new rule.
  • CQM coding for denominator exceptions was not yet completed, so working on coding that.
  • CQM plan to add two new encounter categories (Behavioral Assessment and Preventative Care), map them to correct encounter types(and fix the original items to not map to these encounter type), and add a seq to the categories so can place these new categories near the bottom of selector.
  • Because the SNOMED code type(for diagnostic codes) is not showing all necessary items when search, need to use the SNOMED-CT code type(all clinical codes) for Medical Problems. Will have this as a configuration change after install.
  • Should have initial code to review in 1-2 weeks.
  • 8/8/2016
  • Project was successfully completed.


  • 1/10/13 estimate by Visolve of the time to complete all MU2 certification criteria above. The estimate was approximately 80 work weeks of effort.

Acknowledgments

DEVELOPMENT WORK
(NOTE THERE WERE A TOTAL OF 34 ITEMS THAT WERE WORKED ON)
(BELOW PERCENTAGE IS THE TOTAL AMOUNT OF ITEMS THAT WAS WORKED ON BY THE COMPANY/DEVELOPER)
  • Ensoftek - 44% (15 completed items).
  • ZH Healthcare - 34% (14 completed items).
  • Visolve - 34% (14 completed items).
  • MI-Squared - 24% (8 completed items).
  • Brady Miller - 12% (4 completed items).
  • Jan Jajalla - 9% (3 completed items).
  • Sunset Systems - 9% (3 completed items).
  • Columbia University Health IT Certificate Program - 3% (1 completed item).
HONORABLE MENTIONS FOR VOLUNTEERS
  • Jeff Guillory
  • Ray Magauran
  • John Tenny

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.
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