nology would be required to support a patient’s ability to view,
download, and transmit his or her information to a third party.
Transport standards include two specifications that were developed under ONC’s Direct Project, which enables direct, provid-er-to-provider exchange of information.
Systems must be capable of generating patient summaries,
and in ambulatory settings, systems must enable secure messaging with providers.
A Shift to “Base EHRs” in 2014
ONC also proposes changes to its definition of a “qualified”
EHR, intended to give providers more flexibility.
In response to feedback, ONC would allow professionals and
hospitals the ability to implement only the EHR technology that
they need to demonstrate meaningful use.
Under the current definition, program participants must have
EHR technology that has been tested and certified to all applicable certification criteria adopted for the setting for which it was
designed. Thus, for example, an eligible professional who quali-fies for an exclusion of an objective and associated measure still
must have EHR technology that supports the capability.
Effective 2014, ONC’s rule would require professionals and
hospitals to possess a “base EHR” to support universal fundamental capabilities. They would then require any additional
technology necessary to meet the program objectives and measures for the applicable stage of meaningful use, and the technology needed to capture and report clinical quality measures.
The revised definition reads: “All EPs, EHs, and CAHs must
have EHR technology (including a Base EHR) that has been certified to the 2014 Edition EHR certification criteria that would
support the objectives and measures, and their ability to successfully report the CQMs, for the MU stage that they seek to
Underpinning the objectives related to clinical decision support
Accounting of Disclosures
and patient-specific education resources, ONC proposes the
use of the HL7 Context-Aware Knowledge Retrieval Standard,
International Normative Edition 2010—or “Infobutton.”
The Infobutton standard has been in active use for several
years, ONC notes, and many reference content vendors provide
their products using the standard. Providers are increasingly
using Infobutton to identify and provide patient-specific educa-
Among a set of “additional” comments that ONC requests are
questions related to an EHR’s ability to support accounting of
ONC’s 2011 certification criteria include an optional account-
ing of disclosure certification criteria, requiring EHR technol-
ogy be capable of electronically recording disclosures made for
treatment, payment, and healthcare operations. Systems must
record date, time, patient identification, user identification, and
a description of the disclosure.
Office of the National Coordinator for Health Information
Technology, Department of Health and Human
Services. “Health Information Technology: Standards,
Implementation Specifications, and Certification Criteria
for Electronic Health Record Technology, 2014 Edition;
Revisions to the Permanent Certification Program for
Health Information Technology.” March 7, 2012. www.gpo.
Kevin Heubusch ( firstname.lastname@example.org) is editor-in-chief at the
Journal of AHIMA.