Stage 2 Final Rule: Standards and Certification

Digesting the ONC Standards and Certification Final Rule

My Friday post contained an error (see this post below). Like Icarus I flew too close to the sun and my wings of wax melted. In my case I reported information from the 2014 Standards and Certification Final Rule without being aware of certain ONC clarification. One observant reader gently pointed out to me the error of my ways. You know who you are. Thank you. Allow me to correct the record.

In the post I stated, “If anyone wants to be certified for Stage 1 you better hurry and apply no later than October 3, 2012.  The current Temporary Certification Program is scheduled to end the next day when the Permanent Certification Program becomes effective.” I had based this on text from page 386 of the 2014 Standards and Certification Final Rule, “When the temporary certification program sunsets, ONC-Authorized Testing and Certification Bodies (ONC-ATCBs) will be prohibited from accepting new requests to test and certify EHR technology and will be permitted up to six months after the sunset date to complete all testing and certification activities associated with requests received prior to the sunset date. If these activities are not completed within the 6-month period, the EHR technology would have to be resubmitted for testing and certification under the ONC HIT Certification Program”.

I was under the impression that no Stage 1 (2011 Edition) applications could be accepted after 10/04/2012 when the Permanent Certification Program begins. This is not the case. Surprisingly, applications for 2011 Edition certifications are allowed ALL THE WAY THROUGH 2013. Of course all EPs have to be using 2014 Edition technology on 01/01/2014 and the EHs and CAHs need to be onboard no later that 10/01/2013 but that is another story. Please allow me to report one final nuance to all this before I retire to my weekend of shame for spreading false tales. A vendor can apply for 2011 Edition certification after 10/04/2012 but they will pay a price. They will be exposed to new ONC certification requirements: “We also require that test results used for EHR technology certification be made publicly available” and “we require that ONC-ACBs ensure that EHR technology developers include in their marketing materials and communications notification to potential purchasers any additional types of costs that an EP, EH, or CAH would pay to implement their certified Complete EHR or certified EHR Module in order to attempt to meet MU objectives and measures”.

Post from 9/7/12:

OK, I’ve had time to chew the cud on the 2014 Standards and Certification Final Rule (Stage 2).  Here are two of the things you need to know.

If anyone wants to be certified for Stage 1 you better hurry and apply no later than October 3, 2012.  The current Temporary Certification Program is scheduled to end the next day when the Permanent Certification Program becomes effective. The ONC-Authorized Certification Bodies (ONC-ACB) will then have up to six months to complete work with vendors going after Stage 1 Modular and Complete EHR certification. Stage 2 certification testing will not begin until late this year or early 2013. The intentional vagueness of required functionality in the Certification and Standards Final Rule will have to be converted into Test Procedures and finalized. For Stage 1 NIST had those duties. At this time it is unknown who will do the heavy lifting this time around. Developers and vendors will just have to wait for the 2014 Test Procedures to be released to know exactly what functionality will be required during certification testing. One interesting aspect of the certification timelines is that for a period of time the ONC-Authorized Certification Bodies will be simultaneously testing both Stage 1 and Stage 2 technology. Things might start getting a little complicated over at the CMS Certified Health IT Product List.

The other thing I want to bring to your attention will prove to a boon for specialty EHR developers and vendors. Psychiatrists, radiologists, dentists, oncologists, chiropractors and other specialist EPs had to obtain “complete EHR technology” for Stage 1 program years 2011-2012. In what became very difficult to logically explain dentists had to possess technology to submit immunizations, chiropractors had to have ePrescribing software, and radiologists had to have growth chart functionality in their possession. You get the picture. There was a lot of unnecessary cost and development that did not lead in any way to the “widespread adoption of health information technology”. In a much welcomed adjustment “complete EHR technology” will be redefine for 2014 software: “All EPs, EHs, and CAHs must have EHR technology certified to the 2014 Edition EHR certification criteria that meets the Base EHR definition and would support the objectives, measures, and their ability to successfully report the CQMs, for the MU stage that they seek to achieve.” I’m sure there will be much clamor for clarification around this new concept, but we have plenty of time. After all we have until 2014 to get certified and plenty of time to for EPs, EHRs and CAHS to implement. That was another gift that will apply to 2014 only: “All providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month EHR reporting period.”

Jim Tate is founder of EMR Advocate and a nationally recognized expert on the CMS EHR Incentive Program, certified technology and meaningful use and author of The Incentive Roadmap® The Meaningful Use of Certified Technology: Stage 1