For the purposes of this part:
2014 Edition EHR certification criteria means the certification criteria at Sec. 170.314.
Base EHR means an electronic record of health-related information on an individual that:
(1) Includes patient demographic and clinical health information, such as medical history and problem lists;
(2) Has the capacity:
(i) To provide clinical decision support;
(ii) To support physician order entry;
(iii) To capture and query information relevant to health care quality;
(iv) To exchange electronic health information with, and integrate such information from other sources;
(v) To protect the confidentiality, integrity, and availability of health information stored and exchanged; and
(3) Has been certified to the certification criteria adopted by the Secretary:
(i) For at least one of the four criteria adopted at Sec. 170.314(a)(1), (a)(18), (a)(19), or (a)(20);
(ii) At Sec. 170.314(a)(3);
(iii) At Sec. Sec. 170.314(a)(5) through 170.314(a)(8);
(iv) Both Sec. 170.314(b)(1) and (2); or, both Sec. Sec. 170.314(b)(8) and 170.314(h)(1); or Sec. 170.314(b)(1) and (2) combined with either Sec. 170.314(b)(8) or Sec. 170.314(h)(1), or both Sec. Sec. 170.314(b)(8) and 170.314(h)(1);
(v) At Sec. 170.314(b)(7);
(vi) At Sec. Sec. 170.314(c)(1) through 170.314(c)(3);
(vii) At Sec. Sec. 170.314(d)(1) through 170.314(d)(8);
(4) Has been certified to the certification criteria at Sec. 170.314(c)(1) and (2):
(i) For no fewer than 9 clinical quality measures covering at least 3 domains from the set selected by CMS for eligible professionals, including at least 6 clinical quality measures from the recommended core set identified by CMS; or
(ii) For no fewer than 16 clinical quality measures covering at least 3 domains from the set selected by CMS for eligible hospitals and critical access hospitals.
Certification criteria means criteria:
(1) To establish that health information technology meets applicable standards and implementation specifications adopted by the Secretary; or
(2) That are used to test and certify that health information technology includes required capabilities.
Certified EHR Technology means:
(1) For any Federal fiscal year (FY) or calendar year (CY) up to and including 2014:
(i) A Complete EHR that meets the requirements included in the definition of a Qualified EHR and has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the Secretary for the 2011 Edition EHR certification criteria or the equivalent 2014 Edition EHR certification criteria;
(ii) A combination of EHR Modules in which each constituent EHR Module of the combination has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the Secretary for the 2011 Edition EHR certification criteria or the equivalent 2014 Edition EHR certification criteria, and the resultant combination also meets the requirements included in the definition of a Qualified EHR; or
(iii) EHR technology that satisfies the definition for FY and CY 2015 and subsequent years specified in paragraph (2) of this definition;
(2) For FY and CY 2015 and subsequent years, the following: EHR technology certified under the ONC HIT Certification Program to the 2015 Edition EHR certification criteria that has:
(i) The capabilities required to meet the Base EHR definition; and
(ii) All other capabilities that are necessary to meet the objectives and associated measures under 42 CFR 495.6 and successfully report the clinical quality measures selected by CMS in the form and manner specified by CMS (or the States, as applicable) for the stage of meaningful use that an eligible professional, eligible hospital, or critical access hospital seeks to achieve.
Common MU Data Set means the following data expressed, where indicated, according to the specified standard(s):
(1) Patient name.
(2) Sex.
(3) Date of birth.
(4) Race--the standard specified in Sec. 170.207(f).
(5) Ethnicity--the standard specified in Sec. 170.207(f).
(6) Preferred language--the standard specified in Sec. 170.207(g).
(7) Smoking status--the standard specified in Sec. 170.207(h).
(8) Problems--at a minimum, the version of the standard specified in Sec. 170.207(a)(3).
(9) Medications--at a minimum, the version of the standard specified in Sec. 170.207(d)(2).
(10) Medication allergies--at a minimum, the version of the standard specified in Sec. 170.207(d)(2).
(11) Laboratory test(s)--at a minimum, the version of the standard specified in Sec. 170.207(c)(2).
(12) Laboratory value(s)/result(s).
(13) Vital signs--height, weight, blood pressure, BMI.
(14) Care plan field(s), including goals and instructions.
(15) Procedures--
(i)(A) At a minimum, the version of the standard specified in Sec. 170.207(a)(3) or Sec. 170.207(b)(2); or
(A) At a minimum, the version of the standard specified in Sec. 170.207(a)(3) or Sec. 170.207(b)(2); or
(B) For EHR technology primarily developed to record dental procedures, the standard specified in Sec. 170.207(b)(3).
(ii) Optional. The standard specified at Sec. 170.207(b)(4).
(16) Care team member(s).
Complete EHR, 2014 Edition means EHR technology that meets the Base EHR definition and has been developed to meet, at a minimum, all mandatory 2014 Edition EHR certification criteria for either an ambulatory setting or inpatient setting.
Disclosure is defined as it is in 45 CFR 160.103.
EHR Module means any service, component, or combination thereof that can meet the requirements of at least one certification criterion adopted by the Secretary.
Human readable format means a format that enables a human to read and easily comprehend the information presented to him or her regardless of the method of presentation.
Implementation specification means specific requirements or instructions for implementing a standard.
Qualified EHR means an electronic record of health-related information on an individual that:
(1) Includes patient demographic and clinical health information, such as medical history and problem lists; and
(2) Has the capacity:
(i) To provide clinical decision support;
(ii) To support physician order entry;
(iii) To capture and query information relevant to health care quality; and
(iv) To exchange electronic health information with, and integrate such information from other sources.
Standard means a technical, functional, or performance-based rule, condition, requirement, or specification that stipulates instructions, fields, codes, data, materials, characteristics, or actions. [75 FR 2042, Jan. 13, 2010, as amended at 75 FR 36203, June 24, 2010; 75 FR 44649, July 28, 2010; 77 FR 54283, Sept. 4, 2012; 78 FR 65887, Nov. 4, 2013; 79 FR 52933, Sept. 4, 2014; 79 FR 54477, 54478, Sept. 11, 2014]