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The American Recovery and Reinvestment Act (ARRA) of 2009, requires the certification of an EHR system to ensure that it is a qualified electronic health record under ARRA. EHR systems must meet the Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology established by the Office of the National Coordinator (ONC) for Health Information Technology, Department of Health and Human Services (HHS).

The ARRA definition for a qualified EHR is: (13) QUALIFIED ELECTRONIC HEALTH RECORD.—The term ‘qualified electronic health record’ means an electronic record of health-related information on an individual that— (A) includes patient demographic and clinical health information, such as medical history and problem lists; and (B) 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.

It is mandatory for physicians/medical practices to use qualified EHR systems in order to receive incentive payments available under ARRA.

The Office of the National Coordinator for Health Information Technology, Department of Health and Human Services is also establishing a Certification Program for Health Information Technology which will approve ONC-Authorized Testing and Certification Bodies (ONC-ATCB). These ONC-ATCBs will provide testing and certification of EHR systems. The National Institute of Standards and Technology (NIST) is preparing test tools and test procedures that are to be used in the certification process.

The qualifications or measures to be implemented across 2011-2015 have been divided across three stages with specific objectives.

Stage 1–2011 Objectives

Goal is to electronically capture in coded format and to report health information and to use that information to track key clinical conditions.

  • Capture health information in a coded format electronically
  • Use that information to track key clinical conditions
  • Communicate information for care coordination purposes
  • Report clinical quality measures and public health information

Stage 2–2013 Objectives

  • Goal is to guide and support care processes and care coordination. Disease management
  • Clinical decision support
  • Medication management
  • Support for patient access to their health information
  • Quality measurement and research
  • Bi-directional communication with public health agencies

Stage 3–2015 Objectives

Goal is to achieve and improve performance and support care processes and on key health system outcomes.

  • Improvements in quality, safety and efficiency
  • Decision support for national high-priority conditions
  • Access to self-management tools
  • Access to comprehensive patient data, and improving population health outcomes

Types of Testing and Certification

a. Complete EHRs and EHR Modules
b. Complete EHRs for Ambulatory or Inpatient Settings
c. Integrated Testing and Certification of EHR Modules
Provision for certification of “self-developed” customized EHRs is also included.

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