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 CCD (C32), or CCR
Meaningful Use Stage 2: Consolidated CDA
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 EHR 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 DICOM PS3 – 2011.
Meaningful Use Stage 1: NCPDP 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: Direct Project (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 XDR IHE profile; and secure e-mail, based on the XDM 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.