The proposed rules for Meaningful Use Stage 2 impact the standards that are used for data exchange and the required utilization of interoperability by providers. Some of the areas that are most impacted by the proposed rules include:
- Patient Summary
- Clinical Messages
- Electronic Prescribing
- Transport Specifications
Meaningful Use Stage 1: HL7 is a Standards Developing Organization accredited by the American National Standards Institute (ANSI) to author consensus-based standards representing a board view from healthcare system stakeholders. HL7 has compiled a collection of message form... Continuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the Health Level Seven and American Society for Testing Materials (ASTM) to “harmonize” the data format between ASTM’s Continuity of Care Record (CCR)... (C32), or Continuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between clinical applications. Furthermore, it responds to the need to organize and make transportable a set of basic information about a patient’s health ...
Meaningful Use Stage 2: Consolidated Clinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down the document in generic, unnamed, and non-templated sections. Documents can include discharge summaries, progress notes, history and physical reports,...
Consolidated CDA  is the new document standard for Stage 2 Meaningful Use. CCR and CCD (the C32 version) are no longer included in the ruling. Consolidated CDA was chosen as the new standard because there is now one single implementation guide for CDA, and all of the template constraints are now located in one place. This makes it much easier for implementers and providers to analyze and understand the standard.
The CDA schema itself does not change, so this repackaging of the standard does not impact the ability of an existing application to parse, route, or map a document. When the final rule is released, it is likely that the content of the Care Summary for Consolidated CDA will be very similar to the existing CCD.
The hurdle for providers to demonstrate the electronic transfer of Patient Summaries has also increased. When a provider transitions their patient to another setting of care, they must electronically transmit a summary of care record to an unaffiliated organization that uses a different Certified Electronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The National Alliance for Health Information Technology, April 28, 2008): An electronic record of health-related information on an individual that conform... Technology vendor for at least 10 percent of all transitions of care and referrals. In comparison, Stage 1 only required one test to verify that this functionality was possible.
Meaningful Use Stage 1: HL7 2.3.1 and 2.5.1
Meaningful Use Stage 2: HL7 2.5.1 only
Many criteria that allowed for either HL7 v2.3.1 or HL7 v2.5.1 messaging in Stage 1 will now only allow HL7 v2.5.1 messaging, including:
- Electronic submission of lab results to Public Health agencies.
- Electronic submission for surveillance reporting to Public Health agencies.
- Electronic submission to immunization registries.
- Electronic incorporation and transmission of lab results.
And for the first time, a standard for images was called out in the Meaningful Use criteria. In Stage 2 images must be transferred using Digital Imaging and Communications in Medicine (DICOM) is a common format for image storage. It allows for handling, storing, printing, and transmitting information in medical imaging. Visit DICOM website. Synonyms: Digital Imaging and Communications... PS3 – 2011.
Meaningful Use Stage 1: The National Council for Prescription Drug Programs (NCPDP) creates and promotes the transfer of data related to medications, supplies, and services within the healthcare system through the development of standards and industry guidance. Visit the NC... 8.1 and 10.6
Meaningful Use Stage 2: NCPDP 10.6 only
For electronic prescribing, only NCPDP 10.6 will be allowed for Meaningful Use Stage 2.
Meaningful Use Stage 2: The Direct Project was launched by the ONC within Health and Human Services (HHS) on March 1, 2010. It was initially called NHIN Direct. The object of the Direct Project is to replace the use of faxes, phones, and paper transactions with a simple and... (Push type)
Meaningful Use Stage 2: NwHIN Specifications (Query type)
The Direct Project was initiated to allow for a low-level entry for secure health transport. These specifications are known as push-based, meaning that the patient health data must be pushed-to the next provider. The initiating provider must know the address of the provider needing the data to make the push.
There are two distinct transport types defined by the Direct Project: Point-to-point web services, based on the Cross-enterprise Document Reliable Interchange (XDR) – What it’s used for: The exchange of health documents between health enterprises using a web-based, point-to-point push network communication, permitting direct interchange between EHRs, PHRs ... Integrating the Healthcare Enterprise (IHE) is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. Visit the IHE website. Synonyms: Integrating the Healthcare Enterprise profile; and secure e-mail, based on the Cross-enterprise Document Media Interchange (XDM) – What itss used for: According to IHE, XDM transfers documents and metadata using CDs, USB memory or email attachments. This profile supports environments with minimal capabilities in terms of usin... IHE profile.
The NwHIN Exchange specifications are established to foster the transfer of patient health data on a national scale. These specifications are known as query-based, meaning that patient health data is requested from another provider. This transport is centered on SOAP-Based secure web services. The standard utilizes IHE Cross Community profiles along with OASIS standards for privacy and security.