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H H S Department of Health and Human Services
U.S. Department of Health and Human Services
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What capabilities for the exchange of clinical information do I need to implement?

Information that has been entered into an EHR can be exchanged between providers so that this information is immediately available for care coordination purposes.  The ability to receive timely information at the point of care is important in many instances, for example, when a patient presents in the emergency room or when caring for a patient recently discharged from the hospital.  In many cases, the electric exchange of this information is quicker, more efficient, complete and accurate than other communication methods. Telephone communication between providers, for example, may be time consuming and the provider receiving the call may be unavailable.  Also, written communications sent by fax or mail may result in substantial delays, and handwritten notes may be difficult to read and less complete than electronic notes. The exchange of information through EHR systems can also increase a practice’s efficiency.  In one study (the Arizona Information Exchange Project), 70 percent of providers said that the electronic exchange of information saved time and a similar percentage said that it made the medication reconciliation process more efficient.  

 The Federal government, through the EHR Incentive Program and other initiatives, aims to promote electronic exchange of information through EHRs.  It recognizes, however, that the infrastructure necessary to support electronic exchange is still under development and that electronic exchange is not yet available in all areas of the country.  Thus, for Stage 1, CMS requires a test of the certified EHR technology’s capacity to electronically exchange key clinical information, rather than the exchange of ‘real’ patient information for clinical care purposes.     

Core Objective for Eligible Professionals and Eligible Hospitals:  

  • Capability to exchange key clinical information among providers of care and patient authorized entities electronically.

Measure:

  • Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information.  

This Meaningful Use objective is a core (mandatory) requirement for Stage 1 of the EHR Incentive Program.  It applies to both eligible professionals and eligible hospitals.  This objective must be achieved using certified EHR technology.  

Stage 1 Meaningful Use criteria focuses on electronically capturing health information in a structured format and using that information to track key clinical conditions and communicating that information for care coordination purposes.  While a test of the exchange of health information is required, Stage 1 allows the test to exchange either “dummy” (information that is not affiliated to a particular patient) or information of an actual patient.  Also, the measure does not require that the test be successful.  Stage 1’s test of electronic exchange is designed to prepare providers for Stage 2, which is expected to impose more rigorous demands for health information exchange.  

To test your ability to exchange clinical information, eligible professionals and hospitals must find another entity with which to test their capability.  The test must include the transfer of either actual or ”dummy” data electronically to the chosen other entity.  The other entity must be one that is a different legal entity with distinct certified EHR technology or other system that can accept the information (and not between organizations that share certified EHR technology).

The term “clinical information” refers to all data needed to diagnose and treat disease, such as blood test, microbiology, urinalysis, pathology test, radiology, cardiac imaging, nuclear medicine tests, and pulmonary function tests.  What constitutes “key” clinical information is up to the interpretation of a provider.  Examples of key clinical information might include problem list, medication list, medication allergies, and diagnostic test results.  Eligible hospitals might also consider discharge summaries and procedures to be key clinical information.  

“Diagnostic test results” are defined as all data needed to diagnose and treat disease, such as blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, and pulmonary function tests.  

Also, “patient authorized entities” are defined as any individual or organization which the patient has granted access to their clinical information (insurance company, PHR vendor identified by the patient, etc.)

Key clinical information can be transferred as structured or unstructured data, but if data are available in a structured form, it should be transferred in a structured form. The transfer of structured data is preferred, but if unstructured data (free text, scanned images) is all that is available, this is acceptable.

The measure for this objective is answered by “yes” or “no”; it does not have a numerator or denominator to calculate a threshold for successful fulfillment of Meaningful Use.  The test may be performed before the reporting period begins, but it must be performed before the reporting period ends.

Related Resources:

EHR Incentive Program Final Rule – CMS’ rules and regulations for demonstrating Meaningful Use.  See pages 44360-44362 for detailed information on the clinical information exchange objective and measure.
Creating the Virtual Integrated Delivery System go to exit disclaimer– Article and blog from Health Affairs outlining the potential benefits of EHR and health information technology usage for addressing chronic conditions.
Community HIE Toolkit go to exit disclaimer– The toolkit designed by Colorado Regional Health Information Organization (CORHIO) provides a step-by-step process for organizing your community and participants in Health Information Exchange planning.
Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices go to exit disclaimer– Center for Studying Health System Change study examines the use of electronic medical record by physician practices and their effect on coordination of care.
Instant Access to Clinical Information From Other Providers Leads to Reports of Higher Quality and Lower Costs for Medicaid Beneficiaries – The AHRQ Health Care Innovation Exchange page offers helpful information on the Arizona Medical Information Exchange that provides instant access to the patient health information from other participating facilities at the point of care.
Health IT Adoption Toolbox – The toolbox developed by Health Resources and Services Administration's (HRSA’s) Office of Health Information Technology & Quality (OHITQ) is designed for health centers as well as other safety net and ambulatory care providers seeking to implement health IT.

Developed by the Health Resources and Services Administration as a resource for health centers and other safety net and ambulatory care providers who are seeking to implement health IT.
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