Difference between revisions of "TEST DELETE ME"

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'''SECTION # ''':  Section 170.302(a)—Drug-Drug, Drug- Allergy, Drug-Formulary Checks
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'''SECTION # ''':  Section 170.304(i)—Exchange Clinical Information and Patient Summary Record
  
 
'''MU OBJECTIVE''':   
 
'''MU OBJECTIVE''':   
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Implement drug-drug and drug-allergy interaction checks
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Capability to exchange key clinical information (for example, discharge summary, procedures, problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically.
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The EP, el
  
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'''MU STAGE 1 MEASURE'''  
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'''MU STAGE 1 MEASURE''': Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information.
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The EP/eligible hospital/CAH has enabled this functionality for the entire EHR reporting period
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The EP, eligible hospital or CAH who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals.
  
 
'''CERTIFICATION CRITERION'''
 
'''CERTIFICATION CRITERION'''
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Final Rule Text: §170.304(i)
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(1)  Electronically receive and display.  Electronically receive and display a patient’s summary record, from other providers and organizations including, at a minimum, diagnostic tests results, problem list, medication list, and medication allergy list in accordance with the standard (and applicable implementation specifications) specified in §170.205(a)(1) or §170.205(a)(2).
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Upon receipt of a patient summary record formatted according to the alternative standard, display it in human readable format.
  
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Final Rule Text: §170.302(a).
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(2)  Electronically transmit.  Enable a user to electronically transmit a patient summary record to other providers and organizations including, at a minimum, diagnostic test results, problem list, medication list, and medication allergy list in accordance with:
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(1)  Notifications.  Automatically and electronically generate and indicate in real-time, notifications at the point of care for drug- drug and drug-allergy contraindications based on medication list, medication allergy list, and computerized provider order entry (CPOE).  
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(i) The standard (and applicable implementation specifications) specified in §170.205(a)(1) or §170.205(a)(2); and
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(ii) For the following data elements the applicable standard must be used:
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(2)  Adjustments.  Provide certain users with the ability to adjust notifications provided for drug-drug and drug-allergy interaction checks.
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(A) Problems. The standard specified in §170.207(a)(1) or, at a minimum, the version of the standard specified in §170.207(a)(2);
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(B)  Laboratory test results.  At a minimum, the version of the standard specified in §170.207(c); and
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(C) Medications. The standard specified in §170.207(d).
  
 
'''TEST CRITERIA #'''
 
'''TEST CRITERIA #'''
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§170.302 (a)
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§170.304(i)  
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http://healthcare.nist.gov/docs/170.302.a_DrugDrugDrugAllergy_v1.0.pdf
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http://healthcare.nist.gov/docs/170.304.i_ExchangeClinicalinforPatientSummaryRecordAmb_v1.0.pdf
  
 
'''STANDARDS'''
 
'''STANDARDS'''
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N/A
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§170.205(a)(1)
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§170.205(a)(2)
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§170.205(a)(2)
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§170.207(a)(1)
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§170.207(a)(2)
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§170.207(c)
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§170.207(d)
 
{| class="grey" border="1" cellpadding="2"
 
{| class="grey" border="1" cellpadding="2"
 
! USERS
 
! USERS
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|-
 
|-
 
| All
 
| All
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| core
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| MENU
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| Oroville
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| WorldVistA, et al
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| In development
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| TBD
 
|}
 
|}
  
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'''PREVIOUS NOTES'''
 
'''PREVIOUS NOTES'''
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Note: VistA currently doesn't maintain formularies. This will need to be done with an interface to a 3rd party application, such as the NewCrop ePrescibing service. Drug interactions are handled in VistA but because of the additional requirements, the current approach is that ePrescribing is used to check for allergies and interactions as part of that service using the drug database of the ePrescribing service. The first service being interfaced with it the NewCrop service which uses the First Databank Database that is the same one the VA was slated to use. The VA was slated to release the source code for that project but the project was stopped as it was running over budget and is under review, so we can't expect any help from the VA code anytime soon. The work being done and funded by Oroville hospital as an extension of the CCR-CCD project to provide ePrescribing is vital to this effort. It will be released as open source when it is completed.
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(1) This capability will be provided by the code coming from the CCR-CCD project. The latest project code can be found on http://trac.opensourcevista.net and there are calls almost every Tuesday night at 9 PM Eastern to work on the project. You can sign up to receive notices of the meetings at http://groups.google.com/group/ccd-ccr-project?hl=en . Both a CCR and CCD level 2 are being produced at this time and we are hoping that there will be the capability of transmitting a CCD level 3 in the future as that work is underway. WorldVistA will be submitting a recommendation to the ONCHIT to use both the CCR and CCD as standards for transmission of these health summaries. The production of an XSLT transform to create a CCD level 3 from a CCR, which is the current goal of some work being done by Ken Miller of Solventus as an open source project funded by Oroville Hopital in California, should make this easily possible for healthcare providers.
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(2)This will also be covered by the CCR-CCD project. Either a CCR or CCD level 2 is something that can be extracted at this time. (see above) This particular standard does not specify how the transmission must be done. It is clear that it must be encrypted but it is not clear how it may be transmitted. Then NHIN is mentioned but there it is not clear that other methods of transport are not allowed such as email with an encrypted attachment. (There is mention that if it is physically transported outside of a healthcare facility, it should be encrypted.)
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Eventually the code for ePrescibing can potentially come "in house" so that VistA instances can become their own ePrescribing service with interfaces to the insurance eligibility and formulary databases (proprietary), Sure Scripts and the commercial drug databases, but Phase one of this effort is to use the ePrescibing service software provided by the ePrescribing service and to send demographics, allergies and medication lists to the service and to return lists augmented by additional information brought back from the service, i.e., additional allergies and medications provided by other providers, etc.
 
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The third item may be difficult to provide in the setting of using the ePrescribing service.
 
  
 
'''ACTION ITEMS / NEXT STEPS'''
 
'''ACTION ITEMS / NEXT STEPS'''
  
 
(Add details here)
 
(Add details here)

Revision as of 20:58, 17 August 2010

SECTION # : Section 170.304(i)—Exchange Clinical Information and Patient Summary Record

MU OBJECTIVE: Capability to exchange key clinical information (for example, discharge summary, procedures, problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically. The EP, el

MU STAGE 1 MEASURE: Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information. The EP, eligible hospital or CAH who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals.

CERTIFICATION CRITERION Final Rule Text: §170.304(i) (1) Electronically receive and display. Electronically receive and display a patient’s summary record, from other providers and organizations including, at a minimum, diagnostic tests results, problem list, medication list, and medication allergy list in accordance with the standard (and applicable implementation specifications) specified in §170.205(a)(1) or §170.205(a)(2). Upon receipt of a patient summary record formatted according to the alternative standard, display it in human readable format.

(2) Electronically transmit. Enable a user to electronically transmit a patient summary record to other providers and organizations including, at a minimum, diagnostic test results, problem list, medication list, and medication allergy list in accordance with: (i) The standard (and applicable implementation specifications) specified in §170.205(a)(1) or §170.205(a)(2); and (ii) For the following data elements the applicable standard must be used: (A) Problems. The standard specified in §170.207(a)(1) or, at a minimum, the version of the standard specified in §170.207(a)(2); (B) Laboratory test results. At a minimum, the version of the standard specified in §170.207(c); and (C) Medications. The standard specified in §170.207(d).

TEST CRITERIA # §170.304(i) http://healthcare.nist.gov/docs/170.304.i_ExchangeClinicalinforPatientSummaryRecordAmb_v1.0.pdf

STANDARDS §170.205(a)(1) §170.205(a)(2) §170.205(a)(2) §170.207(a)(1) §170.207(a)(2) §170.207(c) §170.207(d)

USERS CORE / MENU DEVELOPMENT OWNER STATUS
All MENU WorldVistA, et al TBD

SOLUTION DESIGN / TECHNOLOGY

(Add details here)

DELIVERABLE

(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

DEPENDENCIES (Add details here)

COMMENTS / NOTES

(Add details here)

PREVIOUS NOTES (1) This capability will be provided by the code coming from the CCR-CCD project. The latest project code can be found on http://trac.opensourcevista.net and there are calls almost every Tuesday night at 9 PM Eastern to work on the project. You can sign up to receive notices of the meetings at http://groups.google.com/group/ccd-ccr-project?hl=en . Both a CCR and CCD level 2 are being produced at this time and we are hoping that there will be the capability of transmitting a CCD level 3 in the future as that work is underway. WorldVistA will be submitting a recommendation to the ONCHIT to use both the CCR and CCD as standards for transmission of these health summaries. The production of an XSLT transform to create a CCD level 3 from a CCR, which is the current goal of some work being done by Ken Miller of Solventus as an open source project funded by Oroville Hopital in California, should make this easily possible for healthcare providers. (2)This will also be covered by the CCR-CCD project. Either a CCR or CCD level 2 is something that can be extracted at this time. (see above) This particular standard does not specify how the transmission must be done. It is clear that it must be encrypted but it is not clear how it may be transmitted. Then NHIN is mentioned but there it is not clear that other methods of transport are not allowed such as email with an encrypted attachment. (There is mention that if it is physically transported outside of a healthcare facility, it should be encrypted.)

ACTION ITEMS / NEXT STEPS

(Add details here)

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