As part of the Health Information Technology for Economic and Clinical Health Act, the Office of the National Coordinator for Health Information Technology (ONCHIT) released on December 30, 2009, an Interim Final Rule (IFR) that was published in the Federal Register on January 13th. That IFR detailed the initial set of standards, implementation specifications and certifications criteria that must be achieved in order to demonstrate the first stage of the “meaningful use” of electronic health record (EHR) technology and, by doing so, establish eligibility for various incentive programs.
The IFR is meant to address the digital Babylon typifying the current EHR landscape. EHR Technology is a field dominated by a mishmash of competing standards – HL7, SNOMED, ICD-9, ICD-10 PCS, ICD-10 CM, CCHIT, LOINC, NCPDP SCRIPT 5.0, NCPDP SCRIPT 8.1 and SOAP, to name a few of the more prevalent entrants. These various “standards” are promulgated by disparate certification bodies and cover either the method for the exchange of content or attempts to establish a uniform vernacular for the content itself (referred to as “code sets”). The ultimate goal of these regulations is to achieve semantic interoperability through the use of uniform standards and, eventually, settling upon a single standard in hopes of allowing for the transfer, aggregation, and efficient mining of health information across disparate and, currently, largely unlinked systems.
Under the IFR, EHR technology can be made available by suppliers in two formats – either a complete suite addressing all of ONCHIT’s certification requirements or as a modular piece addressing one or more, but not all, of the certification requirements (these incomplete modules must be combined by the eligible professionals, eligible hospitals, or third parties to meet all of the criteria in order to establish “meaningful use”). Throughout the rule, ONCHIT strikes a balance between various standards by allowing for the use of alternative criteria. ONCHIT has expressed a hope that practical experience, when paired with implementation realities, will highlight the key distinctions and advantages of the various standards, and inform the selection of the criteria ultimately chosen in later iterations and updates of the IFR. This adoption of alternative and already existing standards, rather than a single combined approach, is likely due to the time constraints under which the IFR was issued and the limited time for the first round of implementation (beginning as early as October 2010).
The proposed goals of the Stage 1 “meaningful use” criteria focused on capturing health information electronically in a unified format so that the information could be used to track key clinical decisions for care coordination purposes and clinical decision support, and also to report metrics for clinical quality measures and support public health. The key health-related information required to support those goals requires that an EHR include patient demographic and clinical health information such as medical history and problem lists and has the capacity to:
- Provide clinical decision support;
- Support physician order entry;
- Capture and query information relevant to health care quality; and
- Exchange electronic health information with, and integrate such information from, other sources.
The IFR went into effect February 12, 2010 and ONCHIT is seeking comments through March 15, 2010 at 5:00 p.m. Importantly, although the certification criteria are in place, the regulatory structure which will address the process for achieving certification and the establishment of a certification body has yet to be released but is expected in Spring of 2010.
For more information:
For further guidance on how to take full advantage of the EHR incentive programs, please contact any of the following members of the Polsinelli Shughart PC Health Care team:
For further guidance on the technical standards, implementation specifications and certifications criteria, please contact any of the following members of the Polsinelli Shughart PC Science and Technology team:
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