http://xw2k.nist.gov/healthcare/docs/170.304.i_ExchangeClinicalinfoPatientSummaryRecordAmb_v1.1.pdf This is the test for exchanging clinical summaries. The EHR has to be able to read a CCD and a CCR, and to be able to create one of these. Synapse can now create a CCR that validates correctly. At present the minimum data set which is demographics, problem list, allergies, results and medications is done. The others are not necessary but will be added in due course.
http://xw2k.nist.gov/healthcare/docs/170.304.f_ElectronicCopyOfHealthInformation_v1.1.pdf Provide a copy of patient's information in electronic format and also provide a printed copy. This seems to be just the same as the above test except you also need to print out the data. So, no issues here.
http://xw2k.nist.gov/healthcare/docs/170.304.h_ClinicalSummaries_v1.1.pdf Clinical summaries for the patient seems to be the same as above. This time you can just print it out. But if you provide it electronically it has to be readable ... not sure how this differs from the above.
http://xw2k.nist.gov/healthcare/docs/170.302.u_GeneralEncryption_v1.0.pdf This tests the ability of the EMR to encrypt information. So, I think it means that you take a PDF or something like a CCR, and encrypt it. Since we can do RSA public key encryption this should be sufficient.
http://xw2k.nist.gov/healthcare/docs/170.302.v_EncryptionHIE_v1.0.pdf This tests the EMR to encrypt some health information and then transmit it over a secure link. Now Synapse routinely downloads encrypted files from S3 using https, and the encryption used is symmetrical key encryption so this looks good enough.
http://xw2k.nist.gov/healthcare/docs/170.304.i_ExchangeClinicalinfoPatientSummaryRecordAmb_v1.1.pdf Synapse can now read a complete example of a CCR and display it. CCD is next.
http://xw2k.nist.gov/healthcare/docs/170.302.n_AutomateMeasureCalc_v1.0.pdf This is the automatic measure requirement, which calculates percentages of each meaningful use rule. We will have to add some tracking elements for this.
http://xw2k.nist.gov/healthcare/docs/170.304.j_CalcSubmitClinQualityMeasures_v1.1.pdf This is the PQRI test. We have to calculate the 6 core clinical measures and a minimum of 3 others, and then we have to create the report in the PQRI 2008 XML format and then submit them. The test does not specify how the submit process works. I need to work thru these 9 measures and ensure that they can be easily automated.
Plan: Add a check box to the BMI calculator that says we are going to take some action and document it. This will be then added as a digital result of type PQRI, or NQF, and value 128, or 421 respectively. This way we can search on the digital results to see if a weight management plan was initiated for a person who's BMI is outside of parameters.
Plan: look at all the encounters for patients >= 18 who have a diagnosis of hypertension ( ICD-9-CM) over the reporting period who have a total of more than 1 visit and the BP is recorded
There are two elements here. We have to capture the querying of the patient about tobacco usage, and we have to capture the cessation intervention This has a NQF value of 28. I propose that if you update the social history, a result of type NQF of value 28 be recorded. If the patient is a smoker, then we should display some indicator that allows you to capture the smoking cessation intervention and save it as NQF value 28.1
This much the same as PQRI 128, except that counselling applies even though the patient is of normal weight? So, we record PQRI 24 when BMI is recorded and the check box is ticked.
So, I had added the automatic capture of the smoking status as a PQRI event, and also when one saves the BMI as another. Another small button on the consult editor has been added to explicitly capture other PQRI interventions .. I've added a few but not all. Finally I have created a set of rules to be used as HMGs that will remind you on some of the PQRIs.
