DoD EHR v7.0 HL7 EHR-S Profile Coding 040223GB

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					 DoD EHR - For Public Distribution                                                       DoD EHR - HL7 EHR Mapping                                                                          HL7 EHR-S Profile Coding
HL7       HL7                      HL7                            HL7                                                    HL7                       HL7                                           DoD EHR            DoD EHR
EHR       EHR                      EHR                            EHR                                                    EHR                       EHR                                           Constrainable      Implementable
ID        Function                 Function                       Functional                                             Rationale                 Secondary                                     Functional Profile Functional Profile
          Name                     Statement                      Description                                                                      Citation                                      PRIORITY           REQUIRED
                                                                                                                                                                                                 CODING             CODING
                                                                                                                                                                                                 for Ambulatory - for Ambulatory -
                                                                                                                                                                                                 Outpatient       Outpatient
C         DIRECT CARE



C.1       Care Management



C.1.1.0   Health information                                                                                                                       ISO/TS 18308 Final Draft - Health
          capture, management,                                                                                                                     Informatics - Requirements for an
          and review                                                                                                                               Electronic Health Record Architecture;
                                                                                                                                                   ASTM E 1769 Standard Guide for
                                                                                                                                                   Properties of Electronic Health Records and
                                                                                                                                                   Record Systems
C.1.1.1   Enable the provider to   Maintain and identify a        Key identifying information shall be stored for the Supports delivery of                                                       E-Essential       R-Required
          identify and locate a    single patient record for each patient record, and a lookup function shall use this effective healthcare,
          patient record           patient.                       information to uniquely identify the patient.        Improves efficiency,
                                                                                                                       Improves patient safety

C.1.1.2   Capture Patient          Capture demographic            Contact information including addresses and            Supports delivery of                                                    E-Essential       R-Required
          Demographics             information that is reportable phone numbers, as well as key demographic              effective healthcare,
                                   and trackable over time.       information such as date of birth, sex, and other      Improves efficiency,
                                                                  information should be stored for reporting             Improves patient safety
                                                                  purposes and the proper provision of care.

C.1.1.3   Manage Problem List      Create and maintain patient-   A problem list may include, but is not limited to: •   Supports delivery of                                                    E-Essential       R-Required
                                   specific problem lists.        Chronic conditions, diagnoses, or symptoms •           effective healthcare,
                                                                  Visit- or stay-specific conditions, diagnoses, or      Improves efficiency,
                                                                  symptoms Problem lists must be managed over            Facilitates management
                                                                  time, whether over the course of a visit or stay or    of chronic conditions
                                                                  the life of a patient, allowing documentation of
                                                                  history information and tracking the changing
                                                                  character of the problem and its priority. All
                                                                  pertinent dates, including date noted, dates of any
                                                                  changes in problem specification or prioritization,
                                                                  and date of resolution, should be stored. The entire
                                                                  problem history for any problem in the list should
                                                                  be viewable.




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 DoD EHR - For Public Distribution                                                      DoD EHR - HL7 EHR Mapping                                               HL7 EHR-S Profile Coding
HL7       HL7                      HL7                            HL7                                                    HL7                       HL7            DoD EHR            DoD EHR
EHR       EHR                      EHR                            EHR                                                    EHR                       EHR            Constrainable      Implementable
ID        Function                 Function                       Functional                                             Rationale                 Secondary      Functional Profile Functional Profile
          Name                     Statement                      Description                                                                      Citation       PRIORITY           REQUIRED
                                                                                                                                                                  CODING             CODING
                                                                                                                                                                  for Ambulatory - for Ambulatory -
                                                                                                                                                                  Outpatient       Outpatient
C.1.1.4   Manage Medication List   Create and maintain patient-   Medication lists must be managed over time,           Supports delivery of                      E-Essential       R-Required
                                   specific medication lists.     whether over the course of a visit or stay, or the    effective healthcare,
                                                                  lifetime of a patient. All pertinent dates, including Improves patient safety
                                                                  medication start, modification, and end dates,
                                                                  should be stored. The entire medication history for
                                                                  any medication should be viewable. Medication
                                                                  lists should not be limited to medication orders
                                                                  recorded in the EHR, but should also include
                                                                  patient-reported medications.

C.1.1.5   Manage Allergy List      Create and maintain patient-   Allergens should be uniquely identifiable              Supports delivery of                     E-Essential       R-Required
                                   specific allergies and         whenever possible. Allergen lists must be managed      effective healthcare,
                                   reactions.                     over time. All pertinent dates, including patient-     Improves efficiency,
                                                                  reported events, should be stored and the              Facilitates management
                                                                  description of the patient allergy should be           of chronic conditions,
                                                                  modifiable over time. The entire allergy history for   Facilitates self-health
                                                                  any allergen should be viewable.                       management, Improves
                                                                                                                         patient safety


C.1.1.6   Manage Other Summary     Create and maintain patient-   Problem, medication, and allergy lists are             Supports delivery of                     E-Essential       R-Required
          Lists                    specific summary lists not     examples of summary lists. The EHR should              effective healthcare,
                                   otherwise specified.           enable the creation and maintenance of other types     Improves efficiency,
                                                                  of patient summary lists when appropriate for the      Facilitates management
                                                                  patient or a particular care setting.                  of chronic conditions,
                                                                                                                         Improves patient safety


C.1.1.7   Manage Patient History   Capture, review, and manage  Patient historical data related to previous medical      Supports delivery of                     E-Essential       R-Required
                                   medical, procedural, social, diagnoses, surgeries and other procedures                effective healthcare,
                                   and family history including performed on the patient, and relevant health            Facilitates management
                                   the capture of pertinent     conditions of family members should be captured.         of chronic conditions
                                   negative histories.          This data may take the form of a positive or a
                                                                negative such as: "The patient/family member has
                                                                had..." or "The patient/family member has not
                                                                had..."
C.1.1.8   Review chart summary     Make available a             A key feature of an electronic health record is its      Supports delivery of                     E-Essential       R-Required
                                   chronological, filterable,   ability to present, summarize, filter, and facilitate    effective healthcare,
                                   comprehensive review of the searching through the large amounts of data               Improves efficiency,
                                   patient's entire clinical    collected during the provision of patient care.          Facilitates management
                                   history, subject to          Much of this data is date or date-range specific and     of chronic conditions,
                                   confidentiality constraints. should be presented chronologically. Local               Improves patient safety
                                                                confidentiality rules that prohibit certain users of
                                                                the EHR from accessing certain patient
                                                                information must be supported.



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 DoD EHR - For Public Distribution                                                           DoD EHR - HL7 EHR Mapping                                              HL7 EHR-S Profile Coding
HL7        HL7                         HL7                             HL7                                                   HL7                       HL7            DoD EHR            DoD EHR
EHR        EHR                         EHR                             EHR                                                   EHR                       EHR            Constrainable      Implementable
ID         Function                    Function                        Functional                                            Rationale                 Secondary      Functional Profile Functional Profile
           Name                        Statement                       Description                                                                     Citation       PRIORITY           REQUIRED
                                                                                                                                                                      CODING             CODING
                                                                                                                                                                      for Ambulatory - for Ambulatory -
                                                                                                                                                                      Outpatient       Outpatient
C.1.1.9    Capture Other Key Data      Capture, manage, and review     Key data may be captured using standardized code      Supports delivery of                     E-Essential        R-Required
                                       other key data not otherwise    sets or nomenclature, depending on the nature of      effective healthcare,
                                       specified and by a variety of   the data. Data may be entered by a variety of         Improves efficiency,
                                       caregivers.                     caregivers or other users, and the EHR should         Facilitates management
                                                                       maintain documentation of who entered data and        of chronic conditions,
                                                                       when.                                                 Improves patient safety


C.1.1.10   Capture and creation of     Create, addend, and             Clinical documents and notes may be created in a      Supports delivery of                     E-Essential        R-Required
           clinical documents and      authenticate transcribed or     narrative form, with or without using a template.     effective healthcare,
           notes                       directly-entered clinical       They may also be structured documents that result     Improves efficiency,
                                       documentation and notes.        in the capture of coded data. Each of these forms     Facilitates management
                                                                       of clinical documentation are important and           of chronic conditions,
                                                                       appropriate for different users and situations.       Improves patient safety


C.1.1.11   Capture external clinical   Capture clinical documents      Not all clinical documents and notes originate        Supports delivery of                     E-Essential        R-Required
           documents                   and notes originating from      from use of the EHR. Mechanisms for                   effective healthcare,
                                       outside the EHR.                incorporating external clinical documentation and     Improves efficiency,
                                                                       other clinically relevant data should be available.   Facilitates management
                                                                       Data incorporated through these mechanisms            of chronic conditions,
                                                                       should be presented alongside natively captured       Facilitates self-health
                                                                       documentation and notes wherever appropriate.         management, Improves
                                                                                                                             patient safety


C.1.1.12   Capture patient-provided Capture patient-provided           Patients may provide data for entry into the EHR      Supports delivery of                     E-Essential        R-Required
           data                     data.                              or be given a mechanism for entering this data        effective healthcare,
                                                                       directly. Patient-entered data should be viewable     Improves efficiency,
                                                                       and modifiable by the patient at a later time. Some   Facilitates management
                                                                       patient-entered data should be available for use by   of chronic conditions,
                                                                       care providers.                                       Facilitates self-health
                                                                                                                             management

C.1.1.13   Capture historical data     Capture and manage patient-     When first seen by a health care provider, patients   Supports delivery of                     EF-Essential Future R-Required
                                       reported or externally          typically bring with them clinical information from   effective healthcare,
                                       available patient clinical      past encounters. This and similar information must    Facilitates management
                                       history.                        be captured in the EHR and presented alongside        of chronic conditions,
                                                                       natively captured documentation and notes             Improves patient safety
                                                                       wherever appropriate.




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 DoD EHR - For Public Distribution                                                         DoD EHR - HL7 EHR Mapping                                                                             HL7 EHR-S Profile Coding
HL7       HL7                        HL7                             HL7                                                     HL7                       HL7                                           DoD EHR            DoD EHR
EHR       EHR                        EHR                             EHR                                                     EHR                       EHR                                           Constrainable      Implementable
ID        Function                   Function                        Functional                                              Rationale                 Secondary                                     Functional Profile Functional Profile
          Name                       Statement                       Description                                                                       Citation                                      PRIORITY           REQUIRED
                                                                                                                                                                                                     CODING             CODING
                                                                                                                                                                                                     for Ambulatory - for Ambulatory -
                                                                                                                                                                                                     Outpatient       Outpatient
C.1.2.0   Care Planning, Critical                                                                                                                      ISO/TS 18308 Final Draft - Health
          Paths, Protocols                                                                                                                             Informatics - Requirements for an
                                                                                                                                                       Electronic Health Record Architecture.
                                                                                                                                                       (care plans); HIMSS Electronic Health
                                                                                                                                                       Record Definitional Model June 2003
                                                                                                                                                       (protocols); ASTM E 1769 Standard Guide
                                                                                                                                                       for Properties of Electronic Health Records
                                                                                                                                                       and Record Systems
C.1.2.1   Present clinical guidelines Present relevant information   Clinical guidelines may be site specific or industry-   Supports delivery of                                                    EF-Essential Future R-Required
                                      from knowledge resources to    wide standards. The ability to track                    effective healthcare,
                                      support data entry and         implementation/approval dates, modifications and        Improves efficiency,
                                      clinical documentation         relevancy to specific domains or context should be      Facilitates management
                                                                     provided.                                               of chronic conditions,
                                                                                                                             Improves patient safety


C.1.3.0   Medication ordering and                                                                                                                      HIMSS Electronic Health Record
          management                                                                                                                                   Definitional Model June 2003
C.1.3.1   Enable medication          Create prescriptions or other   Different medication orders require different levels    Supports delivery of                                                    E-Essential        R-Required
          ordering                   medication orders with detail   and kinds of order detail, as do medication orders      effective healthcare,
                                     adequate for correct filling    placed in different situations. The EHR must            Improves efficiency,
                                     and administration by           support the correct level and kind of detail in each    Facilitates self-health
                                     pharmacy and clinical staff.    situation. Administration or patient instructions       management, Improves
                                                                     must be available for selection by the ordering         patient safety
                                                                     clinicians, or the ordering clinician must be
                                                                     facilitated in creating such instructions.
                                                                     Appropriate time stamps for all medication related
                                                                     activity must be generated.

C.1.3.2   Support medication         Provide information             When a clinician places an order for a medication, Supports delivery of                                                         E-Essential        R-Required
          formularies                regarding compliance of         that order may or may not comply with a             effective healthcare,
                                     medication orders with          formulary specific to the patients location or      Improves efficiency
                                     formularies.                    insurance coverage. Whether the order complies
                                                                     with the formulary should be communicated to the
                                                                     ordering clinician at an appropriate point to allow
                                                                     the ordering clinician to decide whether to
                                                                     continue with the order. The EHR may also
                                                                     present formulary-compliant alternatives to the
                                                                     medication being ordered.




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 DoD EHR - For Public Distribution                                                         DoD EHR - HL7 EHR Mapping                                                                    HL7 EHR-S Profile Coding
HL7       HL7                        HL7                             HL7                                                    HL7                       HL7                                 DoD EHR            DoD EHR
EHR       EHR                        EHR                             EHR                                                    EHR                       EHR                                 Constrainable      Implementable
ID        Function                   Function                        Functional                                             Rationale                 Secondary                           Functional Profile Functional Profile
          Name                       Statement                       Description                                                                      Citation                            PRIORITY           REQUIRED
                                                                                                                                                                                          CODING             CODING
                                                                                                                                                                                          for Ambulatory - for Ambulatory -
                                                                                                                                                                                          Outpatient       Outpatient
C.1.3.3   Enable documentation of Present to appropriate             In a setting in which medication orders are to be      Supports delivery of                                          EF-Essential Future R-Required
          medication administration clinicians the medications       administered by a clinician rather than the patient    effective healthcare,
                                    that are to be administered to   him or herself, the EHR must provide the               Improves efficiency,
                                    a patient and under what         necessary information for these clinicians to do so.   Improves patient safety
                                    circumstances and permit         This includes presenting the list of medication
                                    documentation of                 orders that are to be administered, administration
                                    administration details.          instructions, times or other conditions of
                                                                     administration, dose and route, etc. Additionally,
                                                                     the clinician must be able to enter into the system
                                                                     information about what actually was or was not
                                                                     administered whether or not these facts conform
                                                                     with the medications as ordered. Appropriate time
                                                                     stamps for all medication related activity must be
                                                                     generated.

C.1.4.0   Orders, Referrals, and                                                                                                                      HIMSS Electronic Health Record
          Results Management                                                                                                                          Definitional Model June 2003
C.1.4.1   Enable ordering of         Submit diagnostic test orders For each orderable item, the appropriate detail and      Supports delivery of                                          E-Essential        R-Required
          diagnostic tests           based on specific care        instructions must be available for the ordering care     effective healthcare,
                                     provider input.               provider to complete. Orders for diagnostic tests        Improves efficiency,
                                                                   should be transmitted to the correct destination for     Improves patient safety
                                                                   completion or generate appropriate requisitions for
                                                                   communication to the relevant resulting agencies.

C.1.4.2   Enable placing of       Submit communicative or            The EHR should facilitate orders that are for the      Supports delivery of                                          O-Optional         M-Maybe
          communication and other administrative orders based        purposes of communication between care                 effective healthcare,
          orders                  on specific care provider          providers rather than the performance of               Improves efficiency,
                                  input.                             diagnostic tests or the administration of              Improves patient safety
                                                                     medications.. Examples include orders to transfer
                                                                     a patient between units or to ambulate a patient.
                                                                     For each orderable item, the appropriate detail and
                                                                     instructions must be available for the ordering care
                                                                     provider to complete. Communication orders
                                                                     should be transmitted to the correct destination for
                                                                     completion.

C.1.4.3   Enable use of order sets   Provide order sets based on     Order sets allow a care provider to choose             Supports delivery of                                          E-Essential        R-Required
                                     provider input or system        common orders for a particular disease state or        effective healthcare,
                                     prompt.                         circumstance according to best practice or other       Improves efficiency,
                                                                     criteria for assembling the order set without having   Facilitates management
                                                                     to generate each order individually. The EHR may       of chronic conditions,
                                                                     recommend order sets in certain conditions or as       Improves patient safety
                                                                     the result of other clinical information being
                                                                     entered into the EHR. Or the order sets may simply
                                                                     be available for use by the ordering care provider.



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 DoD EHR - For Public Distribution                                                          DoD EHR - HL7 EHR Mapping                                                                            HL7 EHR-S Profile Coding
HL7       HL7                        HL7                             HL7                                                      HL7                       HL7                                          DoD EHR            DoD EHR
EHR       EHR                        EHR                             EHR                                                      EHR                       EHR                                          Constrainable      Implementable
ID        Function                   Function                        Functional                                               Rationale                 Secondary                                    Functional Profile Functional Profile
          Name                       Statement                       Description                                                                        Citation                                     PRIORITY           REQUIRED
                                                                                                                                                                                                     CODING             CODING
                                                                                                                                                                                                     for Ambulatory - for Ambulatory -
                                                                                                                                                                                                     Outpatient       Outpatient
C.1.4.4   Enable ordering and        Enable the origination,         The EHR should allow the documentation and               Supports delivery of                                                   E-Essential        R-Required
          tracking of referrals      documentation and tracking      tracking of a referral from one care provider to         effective healthcare,
                                     of referrals between care       another, whether the referred to or referring            Improves efficiency,
                                     provider or care settings,      providers are internal or external to the healthcare     Facilitates management
                                     including clinical guidelines   organization using the EHR. Guidelines for               of chronic conditions
                                     and administrative details of   whether a particular referral for a particular patient
                                     the referral.                   is appropriate in a clinical context and with regard
                                                                     to administrative factors such as insurance should
                                                                     be provided to the care provider at the time the
                                                                     referral is created.

C.1.4.5   Route and manage results Route, manage and present         The EHR should present results of tests in an            Supports delivery of                                                   EF-Essential Future R-Required
                                   current and historical test       easily accessible manner and to any care providers       effective healthcare,
                                   results to appropriate clinical   who may need to access them. Flow sheets, graphs,        Improves efficiency,
                                   personnel for review,             or other tools should be provided to allow care          Facilitates management
                                   filtering and comparison.         providers to view or uncover trends in test data         of chronic conditions,
                                                                     over time. In addition to making results viewable,       Facilitates self-health
                                                                     in many cases it is appropriate for the EHR to send      management, Improves
                                                                     results to appropriate care providers using an           patient safety
                                                                     electronic messaging systems, pagers, or other
                                                                     mechanism. Results may also be routed to patients
                                                                     electronically or in the form of a letter.

C.1.4.6   Enable the ordering of     Communicate with                While the EHR is not expected to fulfill the             Supports delivery of                                                   EF-Essential Future R-Required
          blood products             regulatory-approved Blood       functional requirements of blood bank software, it       effective healthcare,
                                     Bank software to provide        must interact with a blood bank system in the            Improves efficiency,
                                     needed information on blood     creation of orders for blood products and the            Improves patient safety
                                     usage and orders for blood      documentation of use of blood products in the
                                     products.                       provision of care.
C.1.5.0   Consents and                                                                                                                                  American Dental Association Specification
          Authorizations                                                                                                                                No. 1000 for a Standard Clinical
                                                                                                                                                        Architecture for the Structure and Content
                                                                                                                                                        of an Electronic Health Record. (consent)

C.1.5.1   Manage consents and        Create, maintain, and verify    Treatment decisions are documented and include           Facilitates self-health                                                EF-Essential Future R-Required
          authorizations             patient data and treatment      the extent of information, verification levels and       management, Improves
                                     decisions in the form of        exposition of treatment options. This                    patient safety
                                     consents and authorizations     documentation will ensure that decisions made at
                                                                     the discretion of the patient/family/responsible
                                                                     party govern the actual care that is delivered or
                                                                     withheld.




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 DoD EHR - For Public Distribution                                                   DoD EHR - HL7 EHR Mapping                                             HL7 EHR-S Profile Coding
HL7       HL7                      HL7                         HL7                                                  HL7                       HL7            DoD EHR            DoD EHR
EHR       EHR                      EHR                         EHR                                                  EHR                       EHR            Constrainable      Implementable
ID        Function                 Function                    Functional                                           Rationale                 Secondary      Functional Profile Functional Profile
          Name                     Statement                   Description                                                                    Citation       PRIORITY           REQUIRED
                                                                                                                                                             CODING             CODING
                                                                                                                                                             for Ambulatory - for Ambulatory -
                                                                                                                                                             Outpatient       Outpatient
C.1.5.2   Enable capture,          Capture, maintain and       The EHR should provide mechanisms for                Supports delivery of                     EF-Essential Future R-Required
          maintenance and access   provide access to patient   recording advanced directives, the date and          effective healthcare,
          to patient advanced      advanced directives         circumstances under which the directives were        Facilitates self-health
          directives                                           received, and the location of any paper records of   management, Improves
                                                               advanced directives as appropriate.                  patient safety




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 DoD EHR - For Public Distribution                                                        DoD EHR - HL7 EHR Mapping                                               HL7 EHR-S Profile Coding
HL7       HL7                       HL7                            HL7                                                     HL7                       HL7            DoD EHR            DoD EHR
EHR       EHR                       EHR                            EHR                                                     EHR                       EHR            Constrainable      Implementable
ID        Function                  Function                       Functional                                              Rationale                 Secondary      Functional Profile Functional Profile
          Name                      Statement                      Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                    CODING             CODING
                                                                                                                                                                    for Ambulatory - for Ambulatory -
                                                                                                                                                                    Outpatient       Outpatient
C.2       Clinical Decision
          Support


C.2.1.0   Health information
          capture and review
C.2.1.1   Support for standard      Offer rule-based prompts to    When a clinician fills out an assessment, data          Supports delivery of                     EF-Essential Future R-Required
          assessments               support the adherence to       entered triggers the system to prompt the assessor      effective healthcare,
                                    practice guideline standards   to consider issues that would help assure a             improves patient safety
                                    at the point of information    complete/accurate assessment. A simple                  and efficiency, and
                                    capture.                       demographic value or presenting problem (or             facilitates management
                                                                   combination) could provide a template for data          of chronic conditions.
                                                                   gathering that represents best practice in this
                                                                   situation, e.g. Type II diabetic review, fall and
                                                                   70+, rectal bleeding etc. As another example, to
                                                                   appropriately manage the use of restraints, the
                                                                   EHR would provide an online alert defining the
                                                                   requirements for a behavioral health restraint when
                                                                   it is selected. -
C.2.1.2   Support for Patient       Offer rule-based prompts       When a clinician fills out an assessment, data          Supports delivery of                     EF-Essential Future R-Required
          Context-enabled           based on patient-specific data entered is matched against data already in the          effective healthcare,
          Assessments               at the point of information    system to identify potential linkages. For example,     improves patient safety
                                    capture.                       the system could scan the medication list and the       and efficiency, and
                                                                   knowledge base to see if any of the symptoms are        facilitates management
                                                                   side effects of medication already prescribed.          of chronic conditions
                                                                   Important but rare diagnoses could be brought to
                                                                   the doctor’s attention – for instance ectopic
                                                                   pregnancy in a woman of child bearing age who
                                                                   has abdominal pain.

C.2.1.3   Support for identifying   Identify anomalies and         When personal health information is collected           Supports delivery of                     EF-Essential Future R-Required
          anomalies or potential    potential problems, or other   directly during a patient visit input by the patient,   effective healthcare,
          problems                  patient "flags" and provide    or acquired from an external source (e.g. images,       improves patient safety
                                    prompts for consideration at   lab results), it is important to be able to identify    and efficiency, and
                                    the point of information       anomalies or potential problems that may be             facilitates management
                                    capture.                       patient-specific, given the individual's personal       of chronic conditions.
                                                                   health profile, or changes warranting further
                                                                   assessment. For example: significant trends (lab
                                                                   results, weight), reported problems (e.g. insomnia)
                                                                   -




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 DoD EHR - For Public Distribution                                                             DoD EHR - HL7 EHR Mapping                                                                        HL7 EHR-S Profile Coding
HL7         HL7                         HL7                              HL7                                                  HL7                     HL7                                           DoD EHR            DoD EHR
EHR         EHR                         EHR                              EHR                                                  EHR                     EHR                                           Constrainable      Implementable
ID          Function                    Function                         Functional                                           Rationale               Secondary                                     Functional Profile Functional Profile
            Name                        Statement                        Description                                                                  Citation                                      PRIORITY           REQUIRED
                                                                                                                                                                                                    CODING             CODING
                                                                                                                                                                                                    for Ambulatory - for Ambulatory -
                                                                                                                                                                                                    Outpatient       Outpatient
C.2.1.4     Patient and family          Capture patient and family       Decision support functions should permit             Improves patient safety Institute of Medicine (IOM). Committee on     EF-Essential Future R-Required
            preferences                 preferences at the time of       consideration of patient/family preferences and      and facilitates self-   Health Care in America. Crossing the
                                        information intake and           concerns, such as with language, medication          health management.      quality chasm: A new health system for the
                                        integrate them into clinical -   choice, invasive testing, and advanced directives.                           21st century. - National Academy Press:
                                        decision support at all                                                                                       Institute of Medicine. 2001. - Laine C,
                                        appropriate opportunities.                                                                                    Davidoff F. Patient-centered medicine. A
                                                                                                                                                      professional - evolution. JAMA 1996 Jan
                                                                                                                                                      10;275(2):152-6.
C.2.2.0     Care Planning, Critical
            Paths, Protocols
C.2.2.1     Support for disease based                                                                                                                 Payne TH. Computer Decision Support
            protocols (acute care)                                                                                                                    Systems. CHEST 2000; 118:47S-52S. - -
                                                                                                                                                      Hunt DL, Haynes RB, Hanna SE, Smith K.
                                                                                                                                                      Effects of computer-based clinical decision
                                                                                                                                                      support systems on physician performance
                                                                                                                                                      and patient outcomes: a systematic review.
                                                                                                                                                      JAMA 1998;280:1339-1346. -

C.2.2.1.1   Support for standardized    Identify the appropriate         At the time of the clinical encounter, the EHR will Supports delivery of                                                   EF-Essential Future R-Required
            disease based protocols     protocols for the                provide standard care protocols.                    effective healthcare
                                        management of specific                                                               and improves
                                        diseases.                                                                            efficiency.
C.2.2.1.2   Support for context         Identify the appropriate         At the time of the clinical encounter, the EHR will Supports delivery of                                                   EF-Essential Future R-Required
            sensitive disease-based     protocols for the                evaluate patient specific data and recommends       effective healthcare
            protocols                   management of specific           tests, treatments, medications, immunizations,      and improves
                                        diseases that are adjusted to    referrals and evaluations based on a patient’s      efficiency.
                                        the patient specific profile.    health profile.

C.2.2.1.3   Support for on-going        Identify appropriate             The EHR evaluates incoming changes in patient        Supports delivery of                                                  EF-Essential Future R-Required
            management                  modifications to the care        data, such as new lab results or medication orders   effective healthcare
                                        plan in response to new          and provides recommendations for tests,              and improves
                                        clinical data at the time and    treatments, medications, immunizations, referrals    efficiency.
                                        during the course of a           and evaluations as appropriate.
                                        clinical encounter.
C.2.2.1.4   Identification of           Identify deviations from the     The EHR evaluates instances where a chronic          Supports delivery of                                                  EF-Essential Future R-Required
            deviations from standard    standard protocols.              disease management protocol is not being             effective healthcare
            protocols                                                    followed and notifies the provider of such           and improves
                                                                         variances                                            efficiency.
C.2.2.2     Support for chronic                                                                                                                       Hunt DL, Haynes RB, Hanna SE, Smith K.
            disease protocols                                                                                                                         Effects of computer-based clinical decision
                                                                                                                                                      support systems on physician performance
                                                                                                                                                      and patient outcomes: a systematic review.
                                                                                                                                                      JAMA 1998;280:1339-1346. -




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ID          Function                    Function                        Functional                                             Rationale                 Secondary                                 Functional Profile Functional Profile
            Name                        Statement                       Description                                                                      Citation                                  PRIORITY             REQUIRED
                                                                                                                                                                                                   CODING               CODING
                                                                                                                                                                                                   for Ambulatory - for Ambulatory -
                                                                                                                                                                                                   Outpatient       Outpatient
C.2.2.2.1   Support for standard        Identify protocols for          At the time of the clinical encounter, the EHR         Supports delivery of                                                EF-Essential Future R-Required
            chronic disease             standard chronic disease        provides a standard protocol for chronic disease       effective healthcare,
            management-based            management                      management. Examples include standard chronic          improves efficiency,
            protocols                                                   disease order sets, link-outs to reference text.       and supports the
                                                                                                                               management of chronic
                                                                                                                               conditions.
C.2.2.2.2   Support for context         Identify patient specific       The EHR evaluates patient specific data and            Supports delivery of                                                EF-Essential Future R-Required
            sensitive chronic disease   chronic disease management      recommends tests, treatments, medications,             effective healthcare,
            management                  recommendations.                immunizations, referrals and evaluations based on      improves efficiency,
                                                                        a patient’s chronic disease history.                   and supports the
                                                                                                                               management of chronic
                                                                                                                               conditions.
C.2.2.2.3   Support for ongoing         Identify routine chronic        The EHR evaluates incoming changes in patient          Supports delivery of                                                EF-Essential Future R-Required
            chronic disease             disease management              data, such as new lab results or medication orders     effective healthcare,
            management                  recommendations based on        and provides recommendations for tests,                improves efficiency,
                                        changes in patient data.        treatments, medications, immunizations, referrals      and supports the
                                                                        and evaluations.                                       management of chronic
                                                                                                                               conditions.
C.2.2.2.4   Support the identification Identify deviations from         The EHR evaluates instances where a chronic            Supports delivery of                                                EF-Essential Future R-Required
            of deviations from         chronic disease management       disease management protocol is not being               effective healthcare,
            chronic disease            protocols.                       followed and notifies the provider of such             improves efficiency,
            management protocols                                        variances                                              and supports the
                                                                                                                               management of chronic
                                                                                                                               conditions.
C.2.2.3     Support for interactive     Provide the patient with        Patients with specific chronic diseases need to        Supports delivery of      Holman H, Lorig K. Patients as partners in   EF-Essential Future R-Required
            patient chronic disease     decision support for self-      follow self-management plans that may include          effective healthcare,     managing chronic disease. - Partnership is a
            management                  management of a chronic         schedules for home monitoring, lab tests, and          improves efficiency,      prerequisite for effective and efficient
                                        condition in between patient-   clinical check ups; recommendations about              supports the              health care. BMJ - 2000 Feb
                                        provider encounters.            nutrition, physical activity, tobacco use, etc.; and   management of chronic     26;320(7234):526-7 - Lorig KR, Sobel DS,
                                                                        guidance or reminders about medications. The           conditions; and           Stewart AL, Brown BW Jr, Bandura A,
                                                                        patient may be allowed to enter data and track         facilitates self-health   Ritter P, Gonzalez VM, Laurent DD,
                                                                        progress, share data with the provider, or             management.               Holman HR. Evidence suggesting that a
                                                                        communicate with the provider via secure                                         chronic disease self-management program
                                                                        messaging.                                                                       can improve health status while reducing
                                                                                                                                                         hospitalization: a randomized trial. Med
                                                                                                                                                         Care 1999 Jan;37(1):5-14

C.2.3.0     Medications, medication
            management




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ID          Function                  Function                        Functional                                               Rationale                 Secondary                                      Functional Profile Functional Profile
            Name                      Statement                       Description                                                                        Citation                                       PRIORITY           REQUIRED
                                                                                                                                                                                                        CODING             CODING
                                                                                                                                                                                                        for Ambulatory - for Ambulatory -
                                                                                                                                                                                                        Outpatient       Outpatient
C.2.3.1     Support for medication                                                                                                                       Bates DW et al. Effect of computerized
            ordering                                                                                                                                     physician order entry and a team
                                                                                                                                                         intervention on prevention of serious
                                                                                                                                                         medication errors. JAMA 1998;280:1311-
                                                                                                                                                         1316. - - Bates DW et al. The impact of
                                                                                                                                                         computerized physician order entry on
                                                                                                                                                         medication error prevention. JAMIA
                                                                                                                                                         1999;6:313-321. - - Raschke RA et al. A
                                                                                                                                                         computer alert system to prevent injury from
                                                                                                                                                         adverse drug events. JAMA 1998;280:1317-
                                                                                                                                                         1320. - - Chertow GM et al. Guided
                                                                                                                                                         Medication dosing for inpatients with renal
                                                                                                                                                         insufficiency. JAMA 2001;286:2839-2844. -
                                                                                                                                                         - Evans RS et al. A computer-assisted
                                                                                                                                                         management program for antibiotics and
                                                                                                                                                         other anti-infective agents. NEJM 1998;
                                                                                                                                                         338:232-238. - - Hunt DL, Haynes RB,
                                                                                                                                                         Hanna SE, Smith K. Effects of computer-
                                                                                                                                                         based clinical decision support systems on
                                                                                                                                                         physician performance and patient
                                                                                                                                                         outcomes: a systematic review. JAMA
                                                                                                                                                         1998;280:1339-1346. - - Mekhjian HS et al.
                                                                                                                                                         Immediate benefits realized following
                                                                                                                                                         implementation of physician order entry at
                                                                                                                                                         an academic medical institution. JAMIA
                                                                                                                                                         2002;9:529-539. -



C.2.3.1.1   Support for standard      Identify drug-drug, drug-       The EHR provides basic drug-drug, drug-allergy,          Improves patient safety                                                  EF-Essential Future R-Required
            drug, food, allergy and   allergy, drug-food, and         and drug-food interaction checking at levels             and efficiency and
            weight/age-based dosing   weight/age appropriate dose     appropriate to the health care entity. That is, a site   supports delivery of
            interaction checking      recommendations at the          can choose which level of interaction checking to        effective healthcare.
                                      point of medication ordering.   incorporate in the HER such as severe versus
                                                                      moderate.




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EHR         EHR                          EHR                               EHR                                                     EHR                       EHR            Constrainable      Implementable
ID          Function                     Function                          Functional                                              Rationale                 Secondary      Functional Profile Functional Profile
            Name                         Statement                         Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                            CODING             CODING
                                                                                                                                                                            for Ambulatory - for Ambulatory -
                                                                                                                                                                            Outpatient       Outpatient
C.2.3.1.2   Other support for            Identify other potential issues   Additional areas of medication support include          Improves patient safety                  E-Essential        R-Required
            medication ordering          at the point of prescribing.      non-drug interactions , patient preferences,            and efficiency and
                                         Provide suggested                 contraindications specific to the individual (e.g.      supports delivery of
                                         alternatives for these other      pregnancy, occupation); The EHR would provide           effective healthcare.
                                         issues or for standard            alternatives as appropriate, such as a generic
                                         medication issues as              brand, a different dosage, a different drug, or no
                                         appropriate Support               drug (“watchful waiting”). In addition, the EHR
                                         medication administration         will suggest lab order monitoring as appropriate. - -
                                         management and workflow
                                         to alert providers in real-time
                                         to potential administration
                                         errors such as wrong drug,
                                         wrong dose, wrong route,
                                         wrong time and patient.

C.2.3.2     Support for medication       Alert providers in real-time      To reduce medication errors, when a provider            Improves patient safety                  EF-Essential Future R-Required
            administration.              to potential administration       administers a medication, the EHR will support          and efficiency and
                                         errors such as wrong drug,        matching each medication and the patient’s ID           supports delivery of
                                         wrong dose, wrong route,          bracelet and alert the provider in real-time of         effective healthcare.
                                         wrong time and patient in         potential administration errors such as wrong drug,
                                         support of medication             wrong dose, wrong route, wrong time and patient.
                                         administration management         In addition, other clinical check, such as allergies,
                                         and workflow.                     drug-lab and drug-drug interactions can be
                                                                           performed at the time of administration.
                                                                           Documentation of the administration in the
                                                                           electronic MAR is a by-product of administering
                                                                           the medication. Administration details, as well as
                                                                           additional patient information such as injection
                                                                           site, vital signs, and pain assessments, is captured
                                                                           at the point of care, and automatically documented
                                                                           in the patient's electronic health record. In
                                                                           addition, access to online drug monograph
                                                                           information allows providers to check details
                                                                           about a drug and enhances patient education

C.2.4.0     Orders, Referrals, Results
            and Care Management




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EHR         EHR                     EHR                              EHR                                                      EHR                        EHR                                            Constrainable      Implementable
ID          Function                Function                         Functional                                               Rationale                  Secondary                                      Functional Profile Functional Profile
            Name                    Statement                        Description                                                                         Citation                                       PRIORITY           REQUIRED
                                                                                                                                                                                                        CODING             CODING
                                                                                                                                                                                                        for Ambulatory - for Ambulatory -
                                                                                                                                                                                                        Outpatient       Outpatient
C.2.4.1     Support for non-        Identify necessary order entry   Possible order entry components include, but are         Improves patient safety    Payne TH. Computer Decision Support         EF-Essential Future R-Required
            medication ordering     components for non-              not limited to: missing results required for the         and efficiency and         Systems. CHEST 2000; 118:47S-52S. - - -
                                    medication orders that make      order, suggested corollary orders, notification of       promotes the delivery      Stair TO. Reduction of Redundant
                                    the order pertinent, relevant    duplicate orders, institution-specific order             of effective healthcare.   Laboratory Orders by Access to
                                    and resource conservative at     guidelines, guideline-based orders/order sets, order                                Computerized Patient Records. Computers
                                    the time of provider order       sets, order reference text, patient diagnosis specific                              in Emergency Medicine 1998;16:895-897. - -
                                    entry; and flag any              recommendations pertaining to the order. Also, to                                    Sanders DL, Miller RA. The effects on
                                    inappropriate orders based on    include flags for orders that may be inappropriate                                  clinician ordering patterns of a
                                    patient profile. -               or contraindicated for specific patients (e.g. X-rays                               computerized decision support system for
                                                                     for pregnant women). - -                                                            neuroradiology imaging studies. Proc AMIA
                                                                                                                                                         Symp 2001;:583-587. - - Hunt DL, Haynes
                                                                                                                                                         RB, Hanna SE, Smith K. Effects of
                                                                                                                                                         computer-based clinical decision support
                                                                                                                                                         systems on physician performance and
                                                                                                                                                         patient outcomes: a systematic review.
                                                                                                                                                         JAMA 1998;280:1339-1346. - - Chin HL,
                                                                                                                                                         Wallace P. Embedding guidelines into direct
                                                                                                                                                         physician order entry: simple methods,
                                                                                                                                                         powerful results. Proc AMIA Symp
                                                                                                                                                         1999:;221-225.

C.2.4.2     Support for result      Support evaluation and           Examples of result interpretation include, but are       Improves patient           Poom EG, Kuperman GJ, Fiskio J, Bates          EF-Essential Future R-Required
            interpretation          provider notification of         not limited to: abnormal result                          safety, efficiency, and    DW. Real-time notification of laboratory
                                    results within the context of    evaluation/notification, trending of results (such as    supports the delivery of   data requested by users through
                                    the patient's clinical data.     discrete lab values), evaluation of pertinent results    effective healthcare.      alphanumeric pagers. JAMIA 2002;9:217-
                                    SUGGEST: Evaluate results        at the time of provider order entry (such as                                        222. - - Kuperman GL et al. Improving
                                    and notify provider of results   evaluation of lab results at the time of ordering a                                 response to critical laboratory results with
                                    within the context of the        radiology exam), evaluation of incoming results                                     automation. JAMIA 1999;6:512-522. - -
                                    patient’s clinical data. -       against active medication orders. - -                                               Bates DW et al. Reducing the frequency of
                                                                                                                                                         errors in medicine using information
                                                                                                                                                         technology. JAMIA 2001;8(4):299-308. - -

C.2.4.3     Support for referrals
C.2.4.3.1   Support for referral    Evaluate referrals within the The EHR links appropriate data elements or lack             Supports delivery of                                                      EF-Essential Future R-Required
            orders                  context of a patient’s clinical thereof when a healthcare referral is                     effective healthcare,
                                    data. -                         generated/ordered, including pertinent results,           improves efficiency,
                                                                    demographic and insurance data elements, guiding          and facilitates
                                                                    the provider in placing the order. For example,           management of chronic
                                                                    when a urology referral is ordered for urinary            conditions.
                                                                    frequency (this could be captured in the order as a
                                                                    data element) the EHR evaluates recent lab results
                                                                    (like a U/A or urine culture) and advises to
                                                                    provider to do work-up for a basic UTI first before
                                                                    sending the referral.




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EHR         EHR                         EHR                             EHR                                                     EHR                       EHR                                           Constrainable      Implementable
ID          Function                    Function                        Functional                                              Rationale                 Secondary                                     Functional Profile Functional Profile
            Name                        Statement                       Description                                                                       Citation                                      PRIORITY           REQUIRED
                                                                                                                                                                                                        CODING             CODING
                                                                                                                                                                                                        for Ambulatory - for Ambulatory -
                                                                                                                                                                                                        Outpatient       Outpatient
C.2.4.3.2   Support for referral        Evaluate patient data and      For example, the EHR recommends a referral for           Supports delivery of                                                    O-Optional         M-Maybe
            recommendations             suggest appropriate referrals. smoking cessation if nicotine addiction is listed in     effective healthcare,
                                                                       the patient’s problem list or the patient is             improves efficiency,
                                                                       described as a “smoker” through documentation in         and facilitates
                                                                       the EHR, having evaluated the patient’s data for         management of chronic
                                                                       the presence of a prior smoking cessation referral       conditions.
                                                                       order or the actual referral documentation.

C.2.4.4     Support for Care Delivery

C.2.4.4.1   Support for safe blood      Alert providers in real-time    To reduce blood administration errors, when a           Supports delivery of                                                    EF-Essential Future R-Required
            administration              to potential blood              provider administers a blood product, the HER           effective healthcare
                                        administration errors such as   will support matching each blood product and the        and improves patient
                                        wrong blood, wrong cross        patient’s ID bracelet and alert the provider in real-   safety and efficiency
                                        match, wrong source, wrong      time of potential administration errors such as
                                        date and time, and wrong        wrong product, wrong route, wrong time, and
                                        patient.                        wrong patient. In addition, other clinical checks,
                                                                        such as allergy checking, can be performed at the
                                                                        time of administration. Documentation of the
                                                                        administration in the EHR is a by-product of
                                                                        administering the blood product.

C.2.4.4.2   Support for accurate        Alert providers in real-time    To ensure the accuracy of specimen collection,          Supports delivery of                                                    EF-Essential Future R-Required
            specimen collection         to potential specimen           when a provider obtains specimens from a patient,       effective healthcare
                                        collection errors, such as      the EHR matches each specimen collection                and improves patient
                                        wrong patient, wrong            identifiers and the patient’s ID bracelet and alerts    safety and efficiency
                                        specimen type, wrong            the provider in real-time of potential collection
                                        collection means, and wrong     errors such as wrong patient, wrong specimen type,
                                        date and time.                  wrong means of collection, wrong site, and wrong
                                                                        date and time. Documentation of the collection in
                                                                        the EHR is a by-product of collecting the specimen.


C.2.5.0     Health Maintenance:
            Preventive Care and
            Wellness
C.2.5.1     Support for preventive      Identify patient specific       At the time of the patient-provider encounter, the      Supports the delivery     U.S. Preventive Services Task Force.          E-Essential        R-Required
            services and wellness       suggestions/reminders,          EHR provides protocols for preventive care and          of effective healthcare   http://www.ahrq.gov/clinic/uspstfix.htm - -
                                        screening tests/exams, and      wellness. Examples include but are not limited to,      and improves              Reference: Hunt DL, et. al. Effects of
                                        other preventive services in    routine immunizations (adult and well baby care),       efficiency.               Computer-based Clinical Decision Support
                                        support of routine preventive   age and sex appropriate screening exams (such as                                  on Physician Performance and Patient
                                        and wellness patient care       PAP smears).                                                                      Outcomes. JAMA.1998:280;1339-1346.
                                        standards.




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EHR       EHR                        EHR                             EHR                                                       EHR                        EHR                                         Constrainable      Implementable
ID        Function                   Function                        Functional                                                Rationale                  Secondary                                   Functional Profile Functional Profile
          Name                       Statement                       Description                                                                          Citation                                    PRIORITY           REQUIRED
                                                                                                                                                                                                      CODING             CODING
                                                                                                                                                                                                      for Ambulatory - for Ambulatory -
                                                                                                                                                                                                      Outpatient       Outpatient
C.2.5.2   Support for interactive    Notify the patient and/or       Examples include but are not limited to time              Supports the delivery      U.S. Preventive Services Task Force.        E-Essential        R-Required
          reminders for preventive   appropriate provider of those   sensitive patient and provider notification of:           of effective healthcare,   http://www.ahrq.gov/clinic/uspstfix.htm -
          services and wellness      preventive services, tests,     evaluation of patient preventive/wellness needs           improves efficiency;       Reference: Hunt DL, et. al. Effects of
                                     behavioral actions that are     based on past due dates for patient appointments,         and facilitates self-      Computer-based Clinical Decision Support
                                     due for patient in-between      labs, immunizations or exams; also appropriate            health management.         on Physician Performance and Patient
                                     patient-provider encounters.    reminders about lifestyle behaviors such as                                          Outcomes. JAMA.1998:280;1339-1346. - -
                                                                     nutrition, exercise, tobacco use. E.g. a Pap test
                                                                     reminder might be sent to the patient a couple of
                                                                     months prior to the test being due , at 3 month
                                                                     intervals, and then brought to the attention of the
                                                                     administrator or clinician 9 months after it is past
                                                                     due.
C.2.6.0   Supportive Functions
C.2.6.1   Support for              Collect environment and           Standardized surveillance performance measures            Supports the delivery                                                  EF-Essential Future R-Required
          environmental/population surveillance data captured at     that are based on known patterns of disease               of effective healthcare
          monitoring               the time of the patient-          presentation can be identified by aggregating data        and improves
                                   provider encounter for use in     from multiple input mechanisms. Elements                  efficiency.
                                   clinical state monitoring of      include, but are not limited to patient
                                   health risks from the             demographics, resource utilization, presenting
                                   environment and/or                symptoms, acute treatment regimens, laboratory
                                   population.                       and imaging study orders and results and genomic
                                                                     and proteomic data elements. Identification of
                                                                     known patterns of existing diseases involves
                                                                     aggregation and analysis of these data elements by
                                                                     existing relationships. However, the identification
                                                                     of new patterns of disease requires more
                                                                     sophisticated pattern recognition analysis. Early
                                                                     recognition of new patterns requires data points
                                                                     available early in the disease presentation.
                                                                     Demographics, ordering patterns and resource use
                                                                     (e.g., ventilator or intensive care utilization pattern
                                                                     changes) are often available earlier in the
                                                                     presentation of non-predictable diseases.
                                                                     Consumer-generated information is also valuable
                                                                     with respect to surveillance efforts.




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ID        Function                   Function                          Functional                                               Rationale                  Secondary      Functional Profile Functional Profile
          Name                       Statement                         Description                                                                         Citation       PRIORITY           REQUIRED
                                                                                                                                                                          CODING             CODING
                                                                                                                                                                          for Ambulatory - for Ambulatory -
                                                                                                                                                                          Outpatient       Outpatient
C.2.6.2   Support for notification   Alert providers and public        Automated notification is the process by which the       Supports the delivery                     EF-Essential Future R-Required
          and response               health officials with the         system alerts individual care providers or care          of effective healthcare
                                     appropriate level of              managers that an event has occurred and requires         and improves
                                     notifications in the event of a   attention. This process gives a care provider the        efficiency.
                                     health risk.                      ability to determine individual preferences for
                                                                       notification with respect to any patient. The ability
                                                                       to subscribe at the time of ordering to individual
                                                                       data-specific preferences adds significant
                                                                       flexibility to the provider and/or care manager.
                                                                       Preferences for notification should be based on the
                                                                       type and urgency of data as well as the individual
                                                                       care provider's specific clinical privileges within
                                                                       the organization. For example, an elevation of HIV-
                                                                       1 RNA viral load from 20,000 copies / ml might be
                                                                       best managed by the physician privileged to treat
                                                                       AIDS patients and therefore, notification with
                                                                       expectation of action is best sent to that individual.
                                                                       In this example, the Cardiology consultant may be
                                                                       able to subscribe to notification, but with the
                                                                       ability to consult an appropriately privileged
                                                                       physician.



C.2.6.3   Support for monitoring     Monitor if expected actions       Escalation has similar prerequisites as automated        Supports the delivery                     EF-Essential Future R-Required
          and escalation             have been taken in the event      notification. Of great importance to the escalation      of effective healthcare
                                     of a health risk and              process is the ability to match a care provider’s        and improves
                                     subsequent notification and       clinical privileges with the clinical requirements of    efficiency.
                                     escalate notification if they     the escalation.
                                     have not. - If introductory
                                     clause needs to come first,
                                     OK. In the event of a health
                                     risk and the subsequent
                                     notification, monitor if
                                     expected actions have been
                                     taken, escalating notification
                                     if they have not.



C.2.6.4   Support for clinical       Provide evidence-based            Examples include but are not limited to: disease         Supports the delivery                     EF-Essential Future R-Required
          guidance                   guideline-based information       specific protocols, care management protocols            of effective healthcare,
                                     and knowledge to the point        (fall management), and wellness management, as           improves patient safety
                                     of care for use in clinical       well as context-specific links to other knowledge        and efficiency, and
                                     decisions and care planning       resources. For example, when a cough and blood           facilitates management
                                                                       stained sputum is noted, provider is directed to         of chronic conditions.
                                                                       relevant online information.



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EHR       EHR                     EHR                           EHR                                                     EHR                        EHR                                       Constrainable      Implementable
ID        Function                Function                      Functional                                              Rationale                  Secondary                                 Functional Profile Functional Profile
          Name                    Statement                     Description                                                                        Citation                                  PRIORITY             REQUIRED
                                                                                                                                                                                             CODING               CODING
                                                                                                                                                                                             for Ambulatory - for Ambulatory -
                                                                                                                                                                                             Outpatient       Outpatient
C.2.6.5   Support for knowledge   Enable the accessibility of   An individual will be able to find reliable             Facilitates self-health    U.S. Department of Health and Human          EF-Essential Future R-Required
          access for patients     reliable information about    information to answer a health question, follow up      management and             Services, Healthy People 2010, Health
                                  wellness, disease             from a clinical visit, identify treatment options, or   supports the delivery of   Communication Focus Area. (USDHHS
                                  management, treatments, and   other health information needs. The information         effective healthcare.      2000)
                                  related information.          may be linked directly from entries in the PHR, or                                 http://www.healthypeople.gov/document/HT
                                                                may be accessed through other means such as key                                    ML/Volume1/11HealthCom.htm - ; Science
                                                                word searching.                                                                    Panel on Interactive Communication and
                                                                                                                                                   Health. Wired for Health and Well-Being:
                                                                                                                                                   the Emergence of Interactive Health
                                                                                                                                                   Communication. Washington, DC: US
                                                                                                                                                   Department of Health and Human Services,
                                                                                                                                                   US Government Printing Office, April 1999
                                                                                                                                                   .
                                                                                                                                                   http://www.health.gov/scipich/pubs/finalrepo
                                                                                                                                                   rt.htm




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EHR       EHR                      EHR                             EHR                                                      EHR                       EHR            Constrainable      Implementable
ID        Function                 Function                        Functional                                               Rationale                 Secondary      Functional Profile Functional Profile
          Name                     Statement                       Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                     CODING             CODING
                                                                                                                                                                     for Ambulatory - for Ambulatory -
                                                                                                                                                                     Outpatient       Outpatient
C.3       Operations,
          Management and
          Communication
C.3.1.0   Clinical Workflow        Manage tasks related to          Since the electronic health record will replace the     Support delivery of                      EF-Essential Future R-Required
          Tasking                  components of the electronic     paper chart, tasks that were based on the paper         effective healthcare;
                                   health record with               artifact must be effectively managed in the             improve patient safety;
                                   appropriate timeliness.          electronic environment. A set of functions must         improve efficiency
                                                                    exist in the EHR-S to provide a way to
                                                                    accommodate electronically any workflow that
                                                                    previously depended on the existence of a physical
                                                                    artifact (such as the paper chart, a phone message
                                                                    slip) in a paper based system. Tasks differ from
                                                                    other more generic communication among
                                                                    participants in the care process because they are a
                                                                    call to action and target completion of a specific
                                                                    workflow in the context of a patient's health record
                                                                    (including a specific component of the record).
                                                                    Tasks also require disposition (final resolution) as
                                                                    a part of the direct care workflow and may not
                                                                    necessarily require a response back to the original
                                                                    sender like other forms of communication. For
                                                                    example, in a paper based system, physically
                                                                    placing charts in piles for processing creates a
                                                                    physical queue of tasks related to those charts.
                                                                    This queue of tasks (for example, a set of patient
                                                                    phone calls to be returned) shall be supported
                                                                    electronically so that the list (of patients to be
C.3.1.1   Linking of tasks with                                     Tasks is visible to must be linked to a patient or
                                   Linkage of tasks to a relevant called)in the EHR-Sthe appropriate user or role for       Support delivery of                      O-Optional         M-Maybe
          related medical record   part of the electronic health to a component of a patient's medical record. To           effective healthcare;
          entities                 record or to a specific patient. link a task to the related part of an electronic        improve patient safety;
                                                                    healthcare record, the EHR-S requires: a                improve efficiency
                                                                    description of the task; the person (or person-role)
                                                                    expected to complete the task; and the data that is
                                                                    the subject of the task (an instance of a patient or
                                                                    component of the patient's medical record). An
                                                                    example of a well-defined task is "Nurse Johnson
                                                                    must report to Mrs. Smith that the strep test was
                                                                    negative." The EHR-S will facilitate efficient
                                                                    workflow by navigating to the appropriate area of
                                                                    the record to ensure that the appropriate test result
                                                                    for the correct patient is reviewed. Other examples
                                                                    of tasks might involve fulfillment of orders or
                                                                    responding to patient phone calls.




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HL7       HL7                      HL7                            HL7                                                      HL7                       HL7            DoD EHR            DoD EHR
EHR       EHR                      EHR                            EHR                                                      EHR                       EHR            Constrainable      Implementable
ID        Function                 Function                       Functional                                               Rationale                 Secondary      Functional Profile Functional Profile
          Name                     Statement                      Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                    CODING             CODING
                                                                                                                                                                    for Ambulatory - for Ambulatory -
                                                                                                                                                                    Outpatient       Outpatient
C.3.1.2   Clinical Task Routing    Assignment, delegation         Tasks must at all times be assigned to at least one      Support delivery of                      EF-Essential Future R-Required
                                   and/or transmission of tasks   user or role for disposition. Whether the task is        effective healthcare;
                                   to the appropriate parties.    assignable and to whom the task can be assigned          patient safety; improve
                                                                  will be determined by the specific needs of              efficiency
                                                                  practitioners in a care setting. Task-assignment
                                                                  lists help users prioritize and complete assigned
                                                                  tasks. For example, after receiving a phone call
                                                                  from a patient, the triage nurse routes or assigns a
                                                                  task to return the patient's call to the physician who
                                                                  is on call. This decision is made by a person
                                                                  involved in the care process and cannot be easily
                                                                  automated, so the EHR-S will allow, where
                                                                  appropriate, manual assignment of tasks or system
                                                                  triggered task creation and assignment. An
                                                                  example of a system triggered task is when lab
                                                                  results are received electronically, the EHR-S
                                                                  creates a task for clinician review automatically
                                                                  (without the need for human intervention). Task
                                                                  assignment ensures that all tasks are disposed of by
                                                                  the appropriate person or role and allows efficient
                                                                  interaction of entities in the care process.



C.3.1.3   Clinical Task tracking   Track tasks to guarantee that In order to reduce the risk of errors during the care Support delivery of                          EF-Essential Future R-Required
                                   each task is administered to process due to missed tasks, the EHR-S shall           effective healthcare;
                                   and completed appropriately. provide appropriate mechanisms for viewing and         patient safety;
                                                                 tracking unresolved tasks, work lists, task status,
                                                                 unassigned tasks or other tasks where a risk of
                                                                 omission exists. For example, the EHR-S will
                                                                 create a report to show test results that have not
                                                                 been reviewed by the ordering provider based on
                                                                 an interval appropriate to the care setting.




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HL7       HL7                      HL7                            HL7                                                      HL7                     HL7            DoD EHR            DoD EHR
EHR       EHR                      EHR                            EHR                                                      EHR                     EHR            Constrainable      Implementable
ID        Function                 Function                       Functional                                               Rationale               Secondary      Functional Profile Functional Profile
          Name                     Statement                      Description                                                                      Citation       PRIORITY           REQUIRED
                                                                                                                                                                  CODING             CODING
                                                                                                                                                                  for Ambulatory - for Ambulatory -
                                                                                                                                                                  Outpatient       Outpatient
C.3.2.0   Clinical Communication                                  Healthcare requires communications between
                                                                  various participants: patients, doctors, nurses,
                                                                  chronic disease care managers, pharmacies,
                                                                  laboratories, payers, consultants, etc. An effective
                                                                  EHRS supports communication across all relevant
                                                                  participants, reduces the overhead and costs of
                                                                  healthcare-related communications, and provides
                                                                  automatic tracking and reporting. The list of
                                                                  communication participants is determined by the
                                                                  care setting and may change over time. Because of
                                                                  concerns about scalability of the specification over
                                                                  time, communication participants for all care
                                                                  settings are not enumerated here because it would
                                                                  limit the possibilities available to each care setting
                                                                  and implementation.. However, communication
                                                                  between providers and between patients and
                                                                  providers will be supported in all appropriate care
                                                                  settings. Implementation of the EHR-S enables
                                                                  new and more effective channels of
                                                                  communication, significantly improving efficiency
                                                                  and patient care. The communication functions of
                                                                  the EHR-S will eventually change the way
                                                                  participants collaborate and distribute the work of
                                                                  patient care.



C.3.2.1   Inter-provider           Support electronic messaging   Messaging among providers involved in the care           Support delivery of                    E-Essential       R-Required
          communication            (inbound and outbound)         process can range from real time communication           effective healthcare;
                                   between providers to trigger   (for example, fulfillment of an injection while the      patient safety;
                                   or respond to pertinent        patient is in the exam room), to asynchronous            management of chronic
                                   actions in the care process,   communication (for example, consult reports              conditions; improve
                                   document non-electronic        between physicians). Some forms of inter-                efficiency;
                                   communication (such as         practitioner communication will be paper based
                                   phone calls, correspondence    and the EHR must be able to produce appropriate
                                   or other encounters) and       documents.
                                   generate paper message
                                   artifacts where appropriate.




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HL7       HL7                        HL7                               HL7                                                     HL7                      HL7            DoD EHR            DoD EHR
EHR       EHR                        EHR                               EHR                                                     EHR                      EHR            Constrainable      Implementable
ID        Function                   Function                          Functional                                              Rationale                Secondary      Functional Profile Functional Profile
          Name                       Statement                         Description                                                                      Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
C.3.2.3   Pharmacy                   Provide features to enable        When a medication is prescribed, the prescription       Support delivery of                     EF-Essential Future R-Required
          Communication              bidirectional communication       will be routed electronically to the pharmacy. This     effective healthcare;
                                     of information electronically     information will be used to avoid transcription         improve efficiency;
                                     between practitioners and         errors and facilitate detection of potential adverse    management of chronic
                                     pharmacies.                       reactions. Upon filling the prescription,               conditions
                                                                       information will be sent back to the practitioner to
                                                                       indicate that the patient received the medication. If
                                                                       there is a question from the pharmacy, that
                                                                       message can be sent electronically to the provider
                                                                       and presented with their other tasks.

C.3.2.2   Provider/Patient/Family    Trigger or respond to             For example, when test results arrive, the physician    Support delivery of                     EF-Essential Future R-Required
          Communication              electronic messaging              may wish to message the patient with a normal test      effective healthcare;
                                     (inbound and outbound)            result. The patient may wish to request a refill by     management of chronic
                                     between providers and             messaging the physician rather than placing a           conditions; improve
                                     patients or patient               phone call. Patients with chronic disease such as       efficiency; facilitate
                                     representatives with pertinent    asthma may wish to message their peak flow logs         self health management
                                     actions in the care process       to their physician. A hospital may wish to message
                                     while documenting non-            selected patients about a new smoking cessation
                                     electronic communication          program. It is unlikely that the EHR-S can
                                     (such as phone calls,             facilitate self-health management without
                                     correspondence or other           providing a means for communication between
                                     encounters) and generating        patient and practitioner.
                                     paper message artifacts
                                     where appropriate.

C.3.2.4   Patient, Family and Care   Identify and make available       After the practitioner has ordered educational          Support delivery of                     E-Essential        R-Required
          Giver Education            electronically or in print        materials, the EHR-S will provide access to a           effective healthcare;
                                     information any educational       library of educational materials either within the      management of chronic
                                     or support resources for          EHR-S itself or in conjunction with another             conditions; improve
                                     patients, families, and           application. This access could be provided as a         efficiency; facilitate
                                     caregivers that are most          printout or electronically via a message to the         self health management
                                     pertinent for a given health      patient.
                                     concern, condition, or
                                     diagnosis and which are
                                     appropriate for the person (s).

C.3.2.5   Communication with         Support communication and The EHR-S will include features to communicate                  Support delivery of                     EF-Essential Future R-Required
          Medical Devices            presentation of data captured with medical devices as appropriate to the care             effective healthcare;
                                     from medical devices.         setting. Examples include: vital signs, home                Management of
                                                                   diagnostic devices for chronic disease                      chronic conditions
                                                                   management, laboratory machines, bar coded                  Improve efficiency
                                                                   artifacts (medicine, immunizations, demographics,
                                                                   history, identification).




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HL7        HL7                  HL7                               HL7                                                  HL7                         HL7                                           DoD EHR            DoD EHR
EHR        EHR                  EHR                               EHR                                                  EHR                         EHR                                           Constrainable      Implementable
ID         Function             Function                          Functional                                           Rationale                   Secondary                                     Functional Profile Functional Profile
           Name                 Statement                         Description                                                                      Citation                                      PRIORITY           REQUIRED
                                                                                                                                                                                                 CODING             CODING
                                                                                                                                                                                                 for Ambulatory - for Ambulatory -
                                                                                                                                                                                                 Outpatient       Outpatient
S          SUPPORTIVE



S.1        Clinical Support



S.1.1.0    Disease Registries   Enable the automated              The EHR-S supports the addition of new registries    1. Support delivery of      Disease specific registries are exemplified   EF-Essential Future R-Required
                                transfer of formatted             through the addition of formatted data transfer      effective healthcare - 2.   by the long-standing cancer registry system
                                demographic and clinical          protocols but does not necessarily provide support   Improve patient safety -    that exists in each state and supported by
                                information to local disease      for the disease registry itself.                     3. Facilitate               institution-based tumor registries in many
                                specific registries for patient                                                        management of chronic       health care institutions. See
                                monitoring and subsequent                                                              conditions                  http://www.cdc.gov/cancer/npcr/index.htm
                                epidemiological analysis.                                                                                          for more information.

S.1.2.0    Donor Management     Provide capability to capture     Provide capability to capture and share needed       2. Improve patient          Organ donor transplant management is a       EF-Essential Future R-Required
           Support              and share needed information      information on potential organ and blood donors      safety - 4. Improve         complex interaction of many coordinated
                                on potential organ and blood      and recipients. Make this information available to   efficiency                  bodies that extends beyond the institutions
                                donors and recipients.            internal and external donor matching agencies.                                   involved in organ harvesting and
                                                                                                                                                   transplantation. This system is described at
                                                                                                                                                   http://www.optn.org/about/transplantation/m
                                                                                                                                                   atchingProcess.asp. -




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EHR       EHR                    EHR                               EHR                                                 EHR                        EHR                                           Constrainable      Implementable
ID        Function               Function                          Functional                                          Rationale                  Secondary                                     Functional Profile Functional Profile
          Name                   Statement                         Description                                                                    Citation                                      PRIORITY           REQUIRED
                                                                                                                                                                                                CODING             CODING
                                                                                                                                                                                                for Ambulatory - for Ambulatory -
                                                                                                                                                                                                Outpatient       Outpatient
S.1.3.0   Provider Locator       Maintain current directory of     Maintain current directory of provider information 1. Support delivery of      Unique identification of providers along        E-Essential     R-Required
                                 provider information in           in accordance with relevant laws, regulations, and effective healthcare - 4.   with appropriate demographics is already
                                 accordance with relevant          conventions, including full name, address          Improve efficiency          being done in healthcare and will form an
                                 laws, regulations, and            or physical location, and a 24x7                                               essential component of the National
                                 conventions.                      telecommunications address (e.g. phone or pager                                Provider Identifier in the US under HIPAA
                                                                   access number) for the purposes of the following:                              (http://aspe.hhs.gov/admnsimp/nprm/npinpr
                                                                                                                                                  m.pdf). Role based access to systems is an
                                                                                                                                                  essential component of any security system.
                                                                                                                                                  An example of role based access as it
                                                                                                                                                  applies to the EHR by the Open
                                                                                                                                                  Architecture for Secure Internetworking
                                                                                                                                                  Services (OASIS) may be found at
                                                                                                                                                  http://www.cl.cam.ac.uk/~km/MW2001-
                                                                                                                                                  talk.pdf. OASIS is a not-for-profit global
                                                                                                                                                  consortium that drives the development,
                                                                                                                                                  convergence and adoption of e-business
                                                                                                                                                  standards
                                                                                                                                                  (http://www.cl.cam.ac.uk/~km/MW2001-
                                                                                                                                                  talk.pdf). - While current provider location
                                                                                                                                                  is a convenience item that relates mostly to
                                                                                                                                                  customer satisfaction it elevates to a level of
                                                                                                                                                  vital importance when communicating
                                                                                                                                                  critical test results
                                                                                                                                                  (http://www.macoalition.org/documents/CT
                                                                                                                                                  RPractices.pdf)



S.1.3.1   Maintain provider      Maintain a current directory                                                                                                                                   E-Essential       R-Required
          demographics           of practitioners that, in
                                 addition to demographic
                                 information, contains data
                                 needed to determine levels of
                                 access required by the EHR
                                 security system.

S.1.3.2   In facility Location   Provide provider location or                                                                                                                                   E-Essential       R-Required
                                 contact information on a
                                 facility's premises.
S.1.3.3   On Call Location       Provide provider location or                                                                                                                                   E-Essential       R-Required
                                 contact information when on
                                 call.
S.1.3.4   General Location       Provide locations or contact                                                                                                                                   E-Essential       R-Required
                                 information at which the
                                 provider practices, in order to
                                 direct patients or queries.



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EHR       EHR                        EHR                             EHR                                                   EHR                          EHR                                            Constrainable      Implementable
ID        Function                   Function                        Functional                                            Rationale                    Secondary                                      Functional Profile Functional Profile
          Name                       Statement                       Description                                                                        Citation                                       PRIORITY           REQUIRED
                                                                                                                                                                                                       CODING             CODING
                                                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                                                       Outpatient       Outpatient
S.1.4.0   Patient Locator            Maintain current directory of   STATEMENT: Maintain current directory of              1. Support delivery of       Patient location is an essential part of the   E-Essential       R-Required
                                     patient information in          patient information in accordance with relevant       effective healthcare - 2.    patient record, which, by IOM definition in
                                     accordance with relevant        privacy and other applicable laws, regulations, and   Improve patient safety -     their 1991 report forms the basis of an EHR
                                     privacy and other applicable    conventions, including, when available, full name,    3. Facilitate                (http://books.nap.edu/books/0309055326/ht
                                     laws, regulations, and          address or physical location, alternate contact       management of chronic        ml/index.html).
                                     conventions.                    person, primary phone number, and relevant health     conditions - 4. Improve
                                                                     status information for the purposes of the            efficiency - 5. Facilitate
                                                                     following:                                            self-health management




S.1.4.1   Patient's location within a Provide the patient's location Example: The patient census in a hospital setting                                                                                 E-Essential       R-Required
          facility                    information within a facility's
                                      premises.
S.1.4.2   Patient's residence related Provide the patient's                                                                                             Personal health information disclosure is E-Essential            R-Required
          to the provision and        residence information solely                                                                                      required for pubic health purposes, see
          administration of services for purposes related to the                                                                                        http://www.cdc.gov/mmwr/preview/mmwrht
                                      provision and administration                                                                                      ml/su5201a1.htm. -
                                      of services to the patient,
                                      patient transport, and as
                                      required for public health
                                      reporting.
S.1.4.3   Optimize patient bed        Enable management of                                                                                              Information on the recommended isolation O-Optional              M-Maybe
          arrangements                patient bed. Ensure that the                                                                                      of patients with certain infectious diseases
                                      patient's bed arrangements                                                                                        may be found at
                                      within the facility optimize                                                                                      http://www.cdc.gov/ncidod/sars/isolationquar
                                      care and minimize risks of                                                                                        antine.htm with a current list of possible
                                      exposure to contagious                                                                                            infectious agents at
                                      patients. The EHR-S will                                                                                          http://www.cdc.gov/ncidod/sars/executiveord
                                      enable the communication of                                                                                       er040403.htm. - Information on an
                                      bed usage with external                                                                                           instructional role in emergency situations
                                      health entities in times of                                                                                       has been developed by JCAHO and maybe
                                      capacity overload to facilitate                                                                                   found at
                                      efficient bed utilization.                                                                                        http://www.jcaho.org/about+us/public+polic
                                                                                                                                                        y+initiatives/emergency+preparedness.pdf.

S.1.5.0   Demographics and De-       Manage patient                                                                        1. Support delivery of       Patient demographics is an essential part of EF-Essential Future R-Required
          Identification             demographics and                                                                      effective healthcare - 4.    the patient record, which, by IOM definition
                                     identifying information                                                               Improve efficiency - 6.      in their 1991 report that forms the basis of
                                                                                                                           Ensure privacy,              an EHR
                                                                                                                           confidentiality              (http://books.nap.edu/books/0309055326/ht
                                                                                                                                                        ml/index.html).




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HL7       HL7                    HL7                             HL7                                                   HL7                         HL7                                              DoD EHR            DoD EHR
EHR       EHR                    EHR                             EHR                                                   EHR                         EHR                                              Constrainable      Implementable
ID        Function               Function                        Functional                                            Rationale                   Secondary                                        Functional Profile Functional Profile
          Name                   Statement                       Description                                                                       Citation                                         PRIORITY           REQUIRED
                                                                                                                                                                                                    CODING             CODING
                                                                                                                                                                                                    for Ambulatory - for Ambulatory -
                                                                                                                                                                                                    Outpatient       Outpatient
S.1.5.1   Patient demographics   Maintain, archive and update The minimum demographic data set must include                                                                                         E-Essential        R-Required
                                 demographic information in the data required by realm-specific laws governing
                                 accordance with realm-       health care transactions and reporting.
                                 specific recordkeeping
                                 requirements.

S.1.5.2   De-identified Data     Provide patient data in a       When an internal or external party requests patient                               Deidentification of data requires removing EF-Essential Future R-Required
          Request management     fashion that meets local        data and that party requests de-identified data (or                               patient demographic information to the
                                 requirements for de-            is not entitled to identify patient information,                                  point that the individual patient can not be
                                 identification.                 either by law or custom), the EHR-S supplies the                                  identified. Actual requirements for
                                                                 data in a fashion that meets local requirements for                               deidentification will vary based on location
                                                                 de-identification. The EHR-S maintains an audit                                   and specific need. In the US regulations for
                                                                 trail of these requests.                                                          that are viewed as acceptable for complete
                                                                                                                                                   deidentification can be found at
                                                                                                                                                   http://privacyruleandresearch.nih.gov/pr_08.
                                                                                                                                                   asp#8a.

S.1.6.0   Scheduling             Provide the necessary data to   This includes relevant clinical or demographics       1. Support delivery of      IOM Rpt, page 10, "Electronic scheduling         EF-Essential Future R-Required
                                 a scheduling system for         information to prevent the scheduling of              effective healthcare - 2.   systems for admissions, procedures and
                                 optimal efficiency in the       inappropriate procedures for the patient (e.g. X-     Improve patient safety -    visits not only increase efficiency, but also
                                 scheduling of patient care,     Ray for pregnant women)                               3. Facilitate               provide better service to patients (Everett,
                                 for either the patient or a                                                           management of chronic       2002; Hancock and Walter, 1986; Woods,
                                 resource/device.                                                                      conditions - 4. Improve     2001) -
                                                                                                                       efficiency                  http://www.iom.edu/report.asp?id=14391




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EHR       EHR                         EHR                             EHR                           EHR                      EHR                                        Constrainable      Implementable
ID        Function                    Function                        Functional                    Rationale                Secondary                                  Functional Profile Functional Profile
          Name                        Statement                       Description                                            Citation                                   PRIORITY             REQUIRED
                                                                                                                                                                        CODING               CODING
                                                                                                                                                                        for Ambulatory - for Ambulatory -
                                                                                                                                                                        Outpatient       Outpatient
S.2       Measurement,
          Analysis, Research
          and Reports
S.2.1.0   Measurement,                Support measurement and                                       1. Support Delivery of   AHIMA Practice Brief: Data Quality            EF-Essential Future R-Required
          monitoring, and analysis    monitoring of care for                                        Effective Healthcare -   Management Model:
                                      relevant purposes in the                                      2 Improve Patient        http://library.ahima.org/xpedio/groups/public
                                      EHRS.                                                         Safety - 3 Facilitate    /documents/ahima/pub_bok1_000066.html
                                                                                                    management of chronic
                                                                                                    conditions - 4 Improve
                                                                                                    efficiency



S.2.1.1   Outcome Measures            Analyze outcomes of care                                                                                                          EF-Essential Future R-Required
                                      provided to populations, in
                                      facilities, by providers, and
                                      in communities.
S.2.1.2   Aspect of care indicators   Identify indicators that                                                                                                          EF-Essential Future R-Required
                                      further investigation is
                                      needed on aspects of care
                                      provided to populations, in
                                      facilities, by providers, and
                                      in communities
S.2.1.3   Performance and             Support the capture of                                                                                                            EF-Essential Future R-Required
          accountability measures     quality, performance, and
                                      accountability measures to
                                      which
                                      providers/facilities/delivery
                                      systems/communities are
                                      held accountable including
                                      measures related to process,
                                      outcomes, and/or costs of
                                      care – may be used in pay for
                                      performance monitoring and
                                      adherence to best practice
                                      guidelines.




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EHR       EHR                 EHR                            EHR                                                     EHR                         EHR                                      Constrainable      Implementable
ID        Function            Function                       Functional                                              Rationale                   Secondary                                Functional Profile Functional Profile
          Name                Statement                      Description                                                                         Citation                                 PRIORITY            REQUIRED
                                                                                                                                                                                          CODING              CODING
                                                                                                                                                                                          for Ambulatory - for Ambulatory -
                                                                                                                                                                                          Outpatient       Outpatient
S.2.2.0   Report Generation   Provide report generation      Using structured data and/or unstructured text in       1. Support Delivery of      “Claims and encounter data are used to     EF-Essential Future R-Required
                              features for the generation of the patient’s EHR, the EHR-S permits the creation       Effective Healthcare -      monitor and improve outcomes for
                              standard and ad hoc reports. of standard and ad hoc reports for clinical,              2 Improve Patient           numerous preventive services, including
                                                             administrative, and financial decision-making, and      Safety - 3 Facilitate       prenatal care, childhood immunization, and
                                                             for patient use. Reports may be required by             management of chronic       cancer screenings.” p. 8 - Promoting
                                                             patients, regulators, accrediting agencies, payers,     conditions - 4 Improve      Prevention Through Information
                                                             and/or providers/facilities/delivery systems; and, as   efficiency - 5 Facilitate   Technology: - Assessment of Information
                                                             needed, linked with financial and other external        self-health management      Technology in Association of Health Center
                                                             data sources (e.g. sources external to the EHR-S                                    Affiliated Health Plans
                                                             and internal to the health care entity, or data                                     http://www.ahcahp.org/publications/Working
                                                             external to the entity). - - Such reports may include                               %20Papers/Final%20Report%20from%2020
                                                             patient-level reports (e.g., administratively                                       03%20AHCAHP%20IT%20Assessment.pdf
                                                             required patient assessment forms,                                                  -
                                                             admission/transfer/discharge reports, operative and
                                                             procedure reports, consultation reports, drug
                                                             profiles, etc.), provider/facility/delivery system-
                                                             level reports, and population-level reports (e.g.
                                                             including reports on the effectiveness of clinical
                                                             pathways and other evidence-based practices,
                                                             tracking completeness of clinical documentation).




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 DoD EHR - For Public Distribution                                                   DoD EHR - HL7 EHR Mapping                                                                            HL7 EHR-S Profile Coding
HL7       HL7                    HL7                           HL7                                                   HL7                         HL7                                          DoD EHR            DoD EHR
EHR       EHR                    EHR                           EHR                                                   EHR                         EHR                                          Constrainable      Implementable
ID        Function               Function                      Functional                                            Rationale                   Secondary                                    Functional Profile Functional Profile
          Name                   Statement                     Description                                                                       Citation                                     PRIORITY           REQUIRED
                                                                                                                                                                                              CODING             CODING
                                                                                                                                                                                              for Ambulatory - for Ambulatory -
                                                                                                                                                                                              Outpatient       Outpatient
S.3       Administrative and
          Financial


S.3.1.0   Encounter/Episode of   Manage and document the       Using data standards and technologies that support    1. Support Delivery of      AHIMA Practice Brief: Definition of the       E-Essential      R-Required
          Care Management -      health care needed and        interoperability, encounter management promotes       Effective Healthcare -      Health Record for Legal Purposes:
                                 delivered during an episode   patient-centered/oriented care and enables real       2 Improve Patient           http://library.ahima.org/xpedio/groups/public
                                 of care.                      time, immediate point of service, point of care by    Safety - 3 Facilitate       /documents/ahima/pub_bok1_009223.html
                                                               facilitating efficient work flow and operations       management of chronic
                                                               performance to ensure the integrity of (1) the        conditions - 4 Improve
                                                               health record, (2) public health, financial and       efficiency - 5 Facilitate
                                                               administrative reporting, and (3) the healthcare      self-health management
                                                               delivery process. - - This support is necessary for
                                                               direct care functionality that relies on providing
                                                               user interaction and workflows, which are
                                                               configured according to clinical protocols and
                                                               business rules based on encounter specific values
                                                               such as care setting, encounter type (inpatient,
                                                               outpatient, home health, etc), provider type,
                                                               patient's EHR, health status, demographics, and the
                                                               initial purpose of the encounter.




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HL7       HL7                  HL7                              HL7                                                     HL7         HL7                                        DoD EHR               DoD EHR
EHR       EHR                  EHR                              EHR                                                     EHR         EHR                                        Constrainable      Implementable
ID        Function             Function                         Functional                                              Rationale   Secondary                                  Functional Profile Functional Profile
          Name                 Statement                        Description                                                         Citation                                   PRIORITY              REQUIRED
                                                                                                                                                                               CODING                CODING
                                                                                                                                                                               for Ambulatory - for Ambulatory -
                                                                                                                                                                               Outpatient       Outpatient
S.3.1.1   Specialized views    Provide specialized views        Encounter management orchestrates electronic                        Remarks by Tommy G. Thompson,                  EF-Essential Future R-Required
                               and functionality based on       data interchange according to encounter-specific                    Secretary of HHS, NHII Conference 7/1/03:
                               the encounter-specific           values, clinical protocols and business rules. This                 "Why is it that retailers such as L.L. Bean
                               values, clinical protocols and   function "organizes" and "calls" functionalities                    have been able to personalize my shopping
                               business rules                   described in other sections of the EHR Functional                   experience and yours - automatically
                                                                Outline and depends on generic capabilities                         providing the correct sizes and suggestions
                                                                defined by the Information Infrastructure including                 of other items based on what I bought last
                                                                support for security and privacy. - As an example,                  year - but my doctor and pharmacist cannot
                                                                a mobile home health care worker using wireless                     quickly refer to a list of my prescriptions or
                                                                laptop at the patient's home would be presented                     see when I had my last physical?" -
                                                                with a home health care specific workflow                           http://www.hhs.gov/news/speech/2003/03070
                                                                synchronized to the current patient's demographics                  1.html - Key Capabilities of an Electronic
                                                                and care plan and tailored to support the                           Health Record System p. 9 -
                                                                interventions appropriate for this patient, including               http://www.iom.edu/report.asp?id=14391 - -
                                                                chronic disease management protocols. The                           Standards Insight - An Analysis of Health
                                                                workflow would automatically or manually trigger                    Information - Standards Development
                                                                electronic interchanges depending on conditions                     Initiatives - July 2003 -
                                                                arising during the encounter. - The EHR would                       http://www.himss.org/content/files/Standards
                                                                support bidirectional communications with the                       Insight/2003/07-2003.pdf -
                                                                case manager for adjustments to the care plan;
                                                                requests for e-prescriptions from the primary care
                                                                provider; scheduling a consult with a specialist;
                                                                permit the provider to assist the patient with
                                                                communications with other care givers; as well as
                                                                generate necessary prior authorization requests to
S.3.1.2   Encounter specific   Provide assistance in            the patient's health plan, encounter management
                                                                Workflows, based on thesend the information                         The CPR in Eleven Paperless Physicians'      O-Optional          M-Maybe
          functionality        assembling appropriate data,     settings, will assist in determining the appropriate                Offices -
                               supporting data collection       data collection, import, export, extraction, linkages               http://www.himss.org/content/files/proceedin
                               and processing output from       and transformation. - As an example, the EHR-s                      gs/slides/sessions/ses048s.pdf -
                               the encounter.                   would present a pediatrician with diagnostic and                    http://www.himss.org/content/files/proceedin
                                                                procedure codes specific to pediatrics, the patient's               gs/2000/sessions/ses048.pdf -
                                                                demographics, and the patient's health record.
                                                                Business rules in the EHR-S would automatically
                                                                collect necessary data from the patient's health
                                                                record and patient registry. As the provider enters
                                                                data into the EHR-S, triggered workflow processes
                                                                would access and populate appropriate
                                                                transactions and documents to, for example,
                                                                populate an eligibility verification transaction or
                                                                query the immunization registry.




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HL7       HL7                        HL7                             HL7                                                    HL7                         HL7                                        DoD EHR              DoD EHR
EHR       EHR                        EHR                             EHR                                                    EHR                         EHR                                        Constrainable      Implementable
ID        Function                   Function                        Functional                                             Rationale                   Secondary                                  Functional Profile Functional Profile
          Name                       Statement                       Description                                                                        Citation                                   PRIORITY             REQUIRED
                                                                                                                                                                                                   CODING               CODING
                                                                                                                                                                                                   for Ambulatory - for Ambulatory -
                                                                                                                                                                                                   Outpatient       Outpatient
S.3.1.3   Integration of clinical    Enable the inclusion of the     Maximizing the extent to which administrative and                                  Paperless Success: The Value of E-Medical E-Essential           R-Required
          data with administrative   patient's clinical data (for    financial data can be derived or developed from                                    Records -
          and financial data         administrative or financial     clinical data will lessen provider reporting burdens                               http://www.himss.org/content/files/proceedin
                                     purposes) from one or more      and the time it takes to complete administrative                                   gs/2001/sessions/ses045.pdf -
                                     external repositories.          and financial processes such as claim                                              http://www.himss.org/content/files/proceedin
                                                                     reimbursement. This will require a mapping of                                      gs/2001/sessions/ses081.pdf - - "Having
                                                                     clinical terminologies to various administrative                                   clinical data represented with a standardized
                                                                     and financial terminologies.                                                       terminology and in a machine-readable
                                                                                                                                                        format would reduce the significant data
                                                                                                                                                        collection burden at the provider level, as
                                                                                                                                                        well as the associated costs, and would
                                                                                                                                                        likely increase the accuracy of the data
                                                                                                                                                        reported ." IOM Key Capabilities of an
                                                                                                                                                        Electronic Health Record System , pg 14 (
                                                                                                                                                        http://www.iom.edu/report.asp?id=14391 )




S.3.1.4   Integrate device           Support device monitoring,      Promotes patient empowerment, self-                                                Recent examples of: device monitoring     EF-Essential Future R-Required
          monitoring and remote      and remote health services      determination and ability to maintain health status                                (http://www.hi-
          health services such as    such as telehealth by           in the community. Promotes personal health,                                        europe.info/files/2003/9974.htm); remote
          telehealth data            integrating records and data    wellness and preventive care. For example, a                                       monitoring(http://www.devicelink.com/mddi
                                     collected by these means into   diabetic pregnant Mom can self-monitor her                                         /archive/03/06/012.html); and telehealth
                                     the patient's EHR for care      condition from her home and use web TV to report                                   (http://www.mcg.edu/Telemedicine/Index.ht
                                     management, billing, and        to her provider. The same TV-internet connectivity                                 ml) - -
                                     public health reporting         allows her to get dietary and other health
                                     purposes.                       promoting information to assist her with managing
                                                                     her high-risk pregnancy.

S.3.2.0   Information Access for     Support extraction,             Using data standards and technologies that support     1. Support delivery of      AHIMA Practice Brief: Definition of the       EF-Essential Future R-Required
          Supplemental Use           transformation and linkage of   interoperability, information access functionalities   effective healthcare - 2.   Health Record for Legal Purposes:
                                     information from structured     serve primary and secondary record use and             Improve patient safety -    http://library.ahima.org/xpedio/groups/public
                                     data and unstructured text in   reporting with continuous record availability and      3. Facilitate               /documents/ahima/pub_bok1_009223.html -
                                     the patient's EHR for care      access that ensure the integrity of (1) the health     management of chronic       - IOM Key Capabilities of an Electronic
                                     management, financial,          record, (2) public health, financial and               conditions - 4. Improve     Health Record System, p.14 -
                                     administrative, and public      administrative reporting, and (3) the healthcare       efficiency                  http://www.iom.edu/report.asp?id=14391 -
                                     health purposes.                delivery process.




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HL7       HL7                       HL7                              HL7                                                        HL7         HL7                                          DoD EHR            DoD EHR
EHR       EHR                       EHR                              EHR                                                        EHR         EHR                                          Constrainable      Implementable
ID        Function                  Function                         Functional                                                 Rationale   Secondary                                    Functional Profile Functional Profile
          Name                      Statement                        Description                                                            Citation                                     PRIORITY           REQUIRED
                                                                                                                                                                                         CODING             CODING
                                                                                                                                                                                         for Ambulatory - for Ambulatory -
                                                                                                                                                                                         Outpatient       Outpatient
S.3.2.1   Rules-driven clinical     Make available all pertinent                                                                            Remarks by Tommy G. Thompson,                 E-Essential      R-Required
          coding assistance         patient information needed to                                                                           Secretary of HHS, NHII Conference 7/1/03:
                                    support coding of diagnoses,                                                                            We need a health information system that
                                    procedures and outcomes.                                                                                automatically gives health professionals
                                                                                                                                            access to the patient-specific medical
                                                                                                                                            knowledge required for diagnosis and
                                                                                                                                            treatment - the latest research results from
                                                                                                                                            medical journals, the most up-to-date
                                                                                                                                            guidelines, the appropriate public health
                                                                                                                                            notifications. Our doctors then will not have
                                                                                                                                            to depend on their great memories any
                                                                                                                                            more. -
                                                                                                                                            http://www.hhs.gov/news/speech/2003/03070
                                                                                                                                            1.html -

S.3.2.2   Rules-driven financial    Provide financial and            This function is a necessary precondition for the                      NHII03 Standards and Vocabulary Groups       E-Essential       R-Required
          and administrative coding administrative coding            EHR-S' capacity to support the development or                          A&B:
          assistance                assistance based on the          derivation of administrative and financial                             http://aspe.hhs.gov/sp/nhii/Conference03/Sta
                                    structured data and              documentation, reporting and transactions. To a                        ndardsVocabA.ppt,
                                    unstructured text available in   certain extent that clinical data can be mapped to                     http://aspe.hhs.gov/sp/nhii/Conference03/Sta
                                    the encounter documentation.     administrative and financial data. However, where                      ndardsVocabB.PPT
                                                                     there is no map, the EHR-S must support the
                                                                     collection of required administrative and financial
                                                                     data that is not available from non-clinical sources.
                                                                     For example, the HIPAA 837 Professional claim
                                                                     requires the date of the last menstrual cycle for
                                                                     claims involving pregnancy. To support the
                                                                     generation of this transaction, the EHR-S would
                                                                     need to prompt the provider to enter this date when
                                                                     the patient is first determined to be pregnant. The
                                                                     EHR-S would need to make this information
                                                                     available to the billing process.



S.3.2.3   Integrate Cost         Enable the use of cost              The EHR-S could alert the provider or support the                      Medical Informatics for Better and Safer    EF-Essential Future R-Required
          management information management information              provider's query regarding the most cost-effective                     Health Care.
          -                      required to guide users and         services, referrals, devices etc to recommend to the                   http://www.ahrq.gov/data/informatics/inform
                                 workflows.                          patient based on the patient's health plan coverage                    atria.pdf
                                                                     rules. For example, help the provider recommend a
                                                                     specialist from the patient's preferred provider list. -
                                                                      - Note: The Direct care section needs to provide
                                                                     the functionality to guide users based on this
                                                                     information. - Example: alert the provider about co-
                                                                     pays, generic drugs, or other cost policies.




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HL7       HL7                      HL7                            HL7                                                  HL7                        HL7                                        DoD EHR              DoD EHR
EHR       EHR                      EHR                            EHR                                                  EHR                        EHR                                        Constrainable      Implementable
ID        Function                 Function                       Functional                                           Rationale                  Secondary                                  Functional Profile Functional Profile
          Name                     Statement                      Description                                                                     Citation                                   PRIORITY             REQUIRED
                                                                                                                                                                                             CODING               CODING
                                                                                                                                                                                             for Ambulatory - for Ambulatory -
                                                                                                                                                                                             Outpatient       Outpatient
S.3.2.4   Formulary                Present relevant information The EHR-S could alert the provider or support the                                 Medical Informatics for Better and Safer      EF-Essential Future R-Required
          communication            at the point of care regarding provider's query regarding the most cost-effective                              Health Care.
                                   medication formulary.          prescriptions under the patient's health plan's                                 http://www.ahrq.gov/data/informatics/inform
                                                                  formulary.                                                                      atria.pdf
S.3.3.0   Administrative           Support the creation           STATEMENT: Support the creation (including           1. Support Delivery of     IOM Key Capabilities of an Electronic         E-Essential         R-Required
          Transaction Processing   (including using external      using external data sources, if necessary),          Effective Healthcare - -   Health Record System: "Use of
                                   data sources, if necessary),   electronic interchange, and processing of            4. Improve efficiency -    communication and content standards is
                                   electronic interchange, and    transactions listed below that may be necessary for                             equally important in the billing and claims
                                   processing of transactions     encounter management during an episode of care. -                               management area - close coupling of
                                   listed below that may be       - The EHR system shall capture the patient health-                              authorization and prior approvals can, in
                                   necessary for encounter        related information needed for administrative and                               some cases, eliminate delays and confusion.
                                   management during an           financial purposes including reimbursement. - -                                 Additionally, immediate validation of
                                   episode of care                Captures the episode and encounter information to                               insurance eligibility will add value for both
                                                                  pass to administrative or financial processes (e.g.                             providers and patients through improved
                                                                  triggers transmissions of charge transactions as by-                            access to services, more timely payments
                                                                  product of on-line interaction including order                                  and less
                                                                  entry, order statusing, result entry, documentation                             paperwork."http://www.iom.edu/report.asp?i
                                                                  entry, medication administration charting.) - -                                 d=14391 - HIMSS Electronic Health Record
                                                                  Automatically retrieves information needed to                                   Definitional Model - Version 1.0 - - AHIMA
                                                                  verify coverage and medical necessity. - As a                                   Practice Brief: Definition of the Health
                                                                  byproduct of care delivery and documentation,                                   Record for Legal Purposes:
                                                                  captures and presents all patient information                                   http://library.ahima.org/xpedio/groups/public
                                                                  needed to support coding. Ideally performs coding                               /documents/ahima/pub_bok1_009223.html -
                                                                  based on documentation. - - Clinically automated                                - AHIMA Practice Brief: Health Informatics
                                                                  revenue cycle - examples of reduced denials and                                 Standards and Information Transfer:
                                                                  error rates in claims. - - Clinical information                                 Exploring the HIM Role:
                                                                  needed for billing is available on the date of                                  http://library.ahima.org/xpedio/groups/public
                                                                  service. - - Physician and clinical teams do not                                /documents/ahima/pub_bok1_000024.html -
                                                                  perform additional data entry / tasks exclusively to                            - AHIMA Practice Brief: Defining the
                                                                  support administrative or financial processes.                                  Designated Record Set:
                                                                                                                                                  http://library.ahima.org/xpedio/groups/public
                                                                                                                                                  /documents/ahima/pub_bok1_017122.html -




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HL7       HL7                        HL7                               HL7                                                       HL7         HL7                                        DoD EHR             DoD EHR
EHR       EHR                        EHR                               EHR                                                       EHR         EHR                                        Constrainable      Implementable
ID        Function                   Function                          Functional                                                Rationale   Secondary                                  Functional Profile Functional Profile
          Name                       Statement                         Description                                                           Citation                                   PRIORITY            REQUIRED
                                                                                                                                                                                        CODING              CODING
                                                                                                                                                                                        for Ambulatory - for Ambulatory -
                                                                                                                                                                                        Outpatient       Outpatient
S.3.3.1   Enrollment of patients     Enable enrollment of              Expedites determination of health insurance                           Enrolling and Retaining Low Income           EF-Essential Future R-Required
                                     uninsured patients into           coverage, thereby increasing patient access to care.                  families
                                     subsidized and unsubsidized       The EHR could alert the provider that uninsured                       http://cms.hhs.gov/schip/outreach/progress.p
                                     health plans, and enrollment      patients may be eligible for subsidized health                        df - To a Streamlined Approach to - Public
                                     of patients who are eligible      insurance or other health programs because they                       Health Insurance Enrollment -
                                     on the basis of health and/of     meet eligibility criteria based on demographics                       http://www.healtheapp.org/ -
                                     financial status in social        and/or health status. The EHR could be
                                     service and other programs,       automatically updated when such program's
                                     including clinical trials;        eligibility rules change. For examples, the EHR
                                                                       would notify the provider that the uninsured
                                                                       parents of a child enrolled in S-CHIP may now be
                                                                       eligible for a new subsidized health insurance
                                                                       program. The EHR could notify the provider of an
                                                                       uninsured pregnant patient about various programs
                                                                       that the patient may be eligible. The EHR could
                                                                       link to online enrollment forms that could be made
                                                                       available to the patient during the encounter. When
                                                                       enrollment is determined, the EHR would capture
                                                                       health coverage information needed for processing
                                                                       administrative and financial documentation,
                                                                       reports or transactions.



S.3.3.2   Eligibility verification   Enable eligibility verification   Automatically retrieves information needed to                         Immunization registries are having          E-Essential        R-Required
          and determination of       for health insurance and          support verification of coverage at the appropriate                   continual success in increasing vaccination
          coverage;                  special programs, including       juncture in the encounter workflow. Improves                          rates of children
                                     verification of benefits and      patient access to covered care and reduces claim                      (http://www.cdc.gov/mmwr/preview/mmwrh
                                     pre-determination of              denials. When eligibility is verified, the EHR-S                      tml/mm5001a2.htm). - - Electronic
                                     coverage;                         would capture eligibility information needed for                      determination of insurance coverage is a
                                                                       processing administrative and financial                               required HIPAA transaction in the US. See
                                                                       documentation, reports or transactions - updating                     the 270/271 Implementation Guide available
                                                                       or flagging any inconsistent data. In addition to                     at http://www.wpc-
                                                                       health insurance eligibility, this function would                     edi.com/hipaa/HIPAA_40.asp. - -
                                                                       support verification of registration in programs and
                                                                       registries, such as chronic care case management
                                                                       and immunization registries. An EHR-S would
                                                                       likely verify health insurance eligibility prior to the
                                                                       encounter, but would verify registration in case
                                                                       management or immunization registries during the
                                                                       encounter. -




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HL7       HL7                         HL7                              HL7                                                    HL7         HL7                                         DoD EHR            DoD EHR
EHR       EHR                         EHR                              EHR                                                    EHR         EHR                                         Constrainable      Implementable
ID        Function                    Function                         Functional                                             Rationale   Secondary                                   Functional Profile Functional Profile
          Name                        Statement                        Description                                                        Citation                                    PRIORITY           REQUIRED
                                                                                                                                                                                      CODING             CODING
                                                                                                                                                                                      for Ambulatory - for Ambulatory -
                                                                                                                                                                                      Outpatient       Outpatient
S.3.3.3   Service authorizations      Requests, responses and          Automatically retrieves information needed to                      Plans reported that their electronic         O-Optional        M-Maybe
                                      appeals related to service       support verification of medical necessity and prior                connections to various types of providers
                                      authorization, including prior   authorization of services at the appropriate                       enable numerous functions to be completed
                                      authorizations, referrals, and   juncture in the encounter workflow. Improves                       over the Internet, including claims
                                      pre-certification;               timeliness of patient care and reduces claim                       submission, online eligibility verification,
                                                                       denials.                                                           and referral approvals. P.9 - Promoting
                                                                                                                                          Prevention Through Information
                                                                                                                                          Technology: Assessment of Information
                                                                                                                                          Technology in Association of Health Center
                                                                                                                                          Affiliated Health Plans
                                                                                                                                          http://www.ahcahp.org/publications/Working
                                                                                                                                          %20Papers/Final%20Report%20from%2020
                                                                                                                                          03%20AHCAHP%20IT%20Assessment.pdf

S.3.3.4   Support of service          Support health care              Automatically retrieves structured data, including                 Electronic transmission of clinical data for EF-Essential Future R-Required
          requests and claims;        attachments for submitting       lab, imaging and device monitoring data, and                       claims is a required HIPAA transaction in
                                      additional clinical              unstructured text based on rules or requests for                   the US that is under development. See
                                      information in support of        additional clinical information in support of                      http://www.hl7.org/library/committees/ca/hip
                                      service requests and claims;     service requests or claims at the appropriate                      aa%20and%20claims%20attachments%20w
                                                                       juncture in the encounter workflow                                 hite%20paper%2020030920.pdf for details.


S.3.3.5   Claims and encounter      Support claims and                 Automatically retrieves information needed to                      Electronic submission of claims data is a   E-Essential        R-Required
          reports for reimbursement encounter reports for              support claims and encounter reporting at the                      required HIPAA transaction in the US. See
                                    reimbursement                      appropriate juncture in the encounter workflow.                    the 837 Implementation Guide available at
                                                                                                                                          http://www.wpc-
                                                                                                                                          edi.com/hipaa/HIPAA_40.asp. - - - -
S.3.3.6   Health service reports at   Support health service           Clinicians do not perform additional data entry to                 IOM Key Capabilities of an Electronic       EF-Essential Future R-Required
          the conclusion of an        reports to public health         support health management programs and                             Health Record System p. 14
          episode of care.            entities, such as notifiable     reporting.                                                         http://www.iom.edu/report.asp?id=14391 -
                                      condition reports,                                                                                  HIMSS Electronic Health Record
                                      immunization, cancer                                                                                Definitional Model - Version 1.0
                                      registry and discharge data
                                      that a provider may be
                                      required to generate at the
                                      conclusion of an episode of
                                      care.
S.3.3.7   Receipt of clinical and     Provide the appropriate          Example of the use of information: prompts the                                                                 EF-Essential Future R-Required
          administrative responses    information from the receipt     provider about the receipt of an acknowledgement
          and acknowledgements        of clinical and administrative   and displays data relevant to the episode of care at
                                      responses and                    the appropriate juncture in the workflow
                                      acknowledgements for use by
                                      and guidance to EHR-S users




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HL7       HL7                        HL7                             HL7                                                  HL7                         HL7                                          DoD EHR            DoD EHR
EHR       EHR                        EHR                             EHR                                                  EHR                         EHR                                          Constrainable      Implementable
ID        Function                   Function                        Functional                                           Rationale                   Secondary                                    Functional Profile Functional Profile
          Name                       Statement                       Description                                                                      Citation                                     PRIORITY           REQUIRED
                                                                                                                                                                                                   CODING             CODING
                                                                                                                                                                                                   for Ambulatory - for Ambulatory -
                                                                                                                                                                                                   Outpatient       Outpatient
S.3.4.0   Practitioner/Patient       Manage practitioner and                                                              1. Support delivery of      IOM Rpt, page 9, "Effective communication
          Relationship               patient relationships.                                                               effective healthcare - 3.   - among health care team members and with
                                                                                                                          Facilitate management       patients - is critical to the provision of
                                                                                                                          of chronic conditions -     quality health care (Bates and Gawande,
                                                                                                                          4. Improve efficiency       2003; Wanlass et. Al. 1992) -
                                                                                                                                                      http://www.iom.edu/report.asp?id=14391


S.3.4.1   Practitioner assignment    Enable practitioner          Example: In a care setting with multiple providers,                                                                              O-Optional        M-Maybe
                                     assignment based on business where the patient can only see certain kinds of
                                     and clinical practice rules  providers, (or an individual provider); allow the
                                                                  selection of only the appropriate providers (in
                                                                  conjunction with the provider registry).

S.3.4.2   Patient list management    Provide the ability to manage                                                                                                                                 E-Essential       R-Required
                                     patient lists assigned to a
                                     particular provider.

S.3.5.0   Patient to Other Persons   Facilitate access             Facilitate access to/propagation of information        1. Support Delivery of      An EHR used at a professional site should   O-Optional         M-Maybe
          Relationship               to/propagation of information between patient records where patients are related -   Effective Healthcare -      support personal health information
                                     between patient records                                                              3 Facilitate                (http://www.connectingforhealth.org/resourc
                                     where patients are related                                                           management of chronic       es/phwg_final_report.pdf). - - Why Keeping
                                                                                                                          conditions                  Family Health Records is a Good Idea -
                                                                                                                                                      http://www.health-
                                                                                                                                                      minder.com/articles/benefits.htm

S.3.5.1   Related by genealogy        Provide information of                                                                                                                                       O-Optional        M-Maybe
                                      Related by genealogy (blood
                                      relatives)
S.3.5.2   Related by insurance        Provide information of                                                                                                                                       O-Optional        M-Maybe
                                      Related by insurance
                                      (domestic partner, spouse,
                                      guarantor)
S.3.5.3   Related by living situation Provide information of                                                                                                                                       O-Optional        M-Maybe
                                      Related by living situation
                                      (in same household)
S.3.5.4   Related by other means      Provide information of                                                                                          Contact tracing is an essential and required O-Optional        M-Maybe
                                      Related by other means (e.g.                                                                                    feature of public health and has usefulness
                                      epidemiologic exposure)                                                                                         outside of public health when evaluating
                                                                                                                                                      non-reportable infectious disease or
                                                                                                                                                      genetically related conditions. -
                                                                                                                                                      (http://biotech.law.lsu.edu/Books/lbb/x578.ht
                                                                                                                                                      m)




 Version 7.0                                                                                             page 35 of 144                                                                     Version Date: 23 February 2004
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HL7       HL7                          HL7                               HL7                                                    HL7                          HL7                                         DoD EHR            DoD EHR
EHR       EHR                          EHR                               EHR                                                    EHR                          EHR                                         Constrainable      Implementable
ID        Function                     Function                          Functional                                             Rationale                    Secondary                                   Functional Profile Functional Profile
          Name                         Statement                         Description                                                                         Citation                                    PRIORITY           REQUIRED
                                                                                                                                                                                                         CODING             CODING
                                                                                                                                                                                                         for Ambulatory - for Ambulatory -
                                                                                                                                                                                                         Outpatient       Outpatient
S.3.6.0   Acuity and Severity          Provide the capability to         Provide the capability to support and manage           1. Support Delivery of       An Integrated Analysis of Staffing and EF-Essential Future R-Required
                                       support and manage patient        patient acuity/severity of illness/risk adjustment -   Effective Healthcare -       Effects on Patient Outcomes
                                       acuity/severity of illness/risk                                                          2 Improve Patient            http://www.nursingworld.org/OJIN/KEYNO
                                       adjustment                                                                               Safety - - 4 Improve         TES/speech_3.htm
                                                                                                                                efficiency

S.3.6.1                            Support and manage patient
          Patient acuity/severity of                                                                                                                                                                     EF-Essential Future R-Required
          illness/risk adjustment  acuity/severity of illness/risk
                                   adjustments.
S.3.6.2   Provider staff leveling  Adjust provider staffing                                                                                                                                              EF-Essential Future R-Required
          adjustment               levels in relation of patient
                                   acuity/severity and
                                   illness/risk status
S.3.7.0   Automated update for     Update EHR supportive                                                                        1. Support Delivery of                                                   EF-Essential Future R-Required
          EHR supportive content - content on an automated                                                                      Effective Healthcare -
          Update EHR supportive basis.                                                                                          2. Improve Patient
          content on an automated                                                                                               Safety - 3. Facilitate
          basis.                                                                                                                management of chronic
                                                                                                                                conditions - 4. Improve
                                                                                                                                efficiency - 5. Facilitate
                                                                                                                                self-health management


S.3.7.1   Clinical decision support Receive and validate                                                                                                     Nearly all plans (92 percent) reported       E-Essential       R-Required
          system guidelines updates formatted inbound                                                                                                        having one or more IT databases that
                                    communications to facilitate                                                                                             reference clinical criteria, guidelines or
                                    updating of clinical decision                                                                                            protocols. While plans reported a variety of
                                    support system guidelines                                                                                                methods used to communicate clinical
                                                                                                                                                             criteria, guidelines and protocols to
                                                                                                                                                             providers, e-mail and electronic newsletters
                                                                                                                                                             are seldom used and only one of the most
                                                                                                                                                             widely used methods is related to IT. p 3 -
                                                                                                                                                             Promoting Prevention Through Information
                                                                                                                                                             Technology: Assessment of Information
                                                                                                                                                             Technology in Association of Health Center
                                                                                                                                                             Affiliated Health Plans
                                                                                                                                                             http://www.ahcahp.org/publications/Working
                                                                                                                                                             %20Papers/Final%20Report%20from%2020
                                                                                                                                                             03%20AHCAHP%20IT%20Assessment.pdf




 Version 7.0                                                                                                    page 36 of 144                                                                      Version Date: 23 February 2004
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HL7       HL7                     HL7                             HL7                           HL7         HL7                                        DoD EHR             DoD EHR
EHR       EHR                     EHR                             EHR                           EHR         EHR                                        Constrainable      Implementable
ID        Function                Function                        Functional                    Rationale   Secondary                                  Functional Profile Functional Profile
          Name                    Statement                       Description                               Citation                                   PRIORITY            REQUIRED
                                                                                                                                                       CODING              CODING
                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                       Outpatient       Outpatient
S.3.7.2   Patient education       Receive and validate                                                      Patient Provider Communication Tools        E-Essential        R-Required
          material Updates        formatted inbound                                                         http://www.chcf.org/documents/ihealth/Patie
                                  communications to facilitate                                              ntProviderCommunicationTools.pdf - -
                                  updating of patient education                                             Informing Patients A Guide for Providing
                                  material                                                                  Patient Health Information -
                                                                                                            http://www.pubmedcentral.nih.gov/articleren
                                                                                                            der.fcgi?artid=61336 - - Promoting
                                                                                                            Prevention Through Information
                                                                                                            Technology: Assessment of Information
                                                                                                            Technology in Association of Health Center
                                                                                                            Affiliated Health Plans -
                                                                                                            http://www.ahcahp.org/publications/Working
                                                                                                            %20Papers/Final%20Report%20from%2020
                                                                                                            03%20AHCAHP%20IT%20Assessment.pdf

S.3.7.3   Physician continuing    Receive and validate                                                      Facility provided continuing education to    EF-Essential Future R-Required
          education information   formatted inbound                                                         professional staff is a recommended
          updates                 communications to facilitate                                              function. See http://dbapps.ama-
                                  updating of physician                                                     assn.org/iwcf/pf_online/pf_online?f_n=result
                                  continuing education                                                      Link&doc=policyfiles/HOD/H-
                                  information                                                               225.997.HTM&s_t=continuing+education&
                                                                                                            catg=AMA/CnB&catg= -
                                                                                                            AMA/CEJA&catg=AMA/HOD&&nth=1&&
                                                                                                            st_p=0&nth=7&)
S.3.7.4   Patient reminder        Receive and validate                                                      Plans reported using IT systems to support   E-Essential         R-Required
          information updates     formatted inbound                                                         numerous activities and processes, such as
                                  communications to facilitate                                              utilization management, disease
                                  updating of patient reminder                                              management and targeted mailings to
                                  information from external                                                 members. P. 3 Promoting Prevention
                                  sources such as Cancer or                                                 Through Information Technology:
                                  Immunization Registries                                                   Assessment of Information Technology in
                                                                                                            Association of Health Center Affiliated
                                                                                                            Health Plans
                                                                                                            http://www.ahcahp.org/publications/Working
                                                                                                            %20Papers/Final%20Report%20from%2020
                                                                                                            03%20AHCAHP%20IT%20Assessment.pdf
                                                                                                            -
S.3.7.5   Public health related   Receive and validate                                                      Public health response information changes EF-Essential Future R-Required
          updates                 formatted inbound                                                         continually and the ability to access the
                                  communications to facilitate                                              latest data by EHR users is essential
                                  updating of public health                                                 (http://www.cdc.gov/phin/components/PHIN
                                  reporting guidelines                                                      %20Brochure%20HAN%20.ppt). -




 Version 7.0                                                                           page 37 of 144                                             Version Date: 23 February 2004
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HL7       HL7                       HL7                           HL7                                                  HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                       EHR                           EHR                                                  EHR                        EHR            Constrainable      Implementable
ID        Function                  Function                      Functional                                           Rationale                  Secondary      Functional Profile Functional Profile
          Name                      Statement                     Description                                                                     Citation       PRIORITY           REQUIRED
                                                                                                                                                                 CODING             CODING
                                                                                                                                                                 for Ambulatory - for Ambulatory -
                                                                                                                                                                 Outpatient       Outpatient
I.1       INFORMATION
          INFRASTRUCTURE


I.1.1     Security



I.1.1.0   EHR Information Security Secure the EHR information. The EHRS is required to manage EHR information          1. Support delivery of                    E-Essential       R-Required
                                                               securely. For this, all EHRS applications must          effective healthcare 2.
                                                               ensure the authentication, authorization of entities    Improve patient safety
                                                               (e.g. user and applications) and control access to      3 Facilitate
                                                               the EHR information.                                    management of chronic
                                                                                                                       conditions 4. Improve
                                                                                                                       efficiency 5. Facilitate
                                                                                                                       self-health
                                                                                                                       management 6. Ensure
                                                                                                                       privacy, confidentiality




I.1.1.1   Entity Authentication     Authenticate EHRS users     Both users and application are subject to              1. Support delivery of                    E-Essential       R-Required
                                    and/or entities before      authentication. EHRS application must provide          effective healthcare 2.
                                    allowing access to an EHRS. mechanisms for users and applications to be            Improve patient safety
                                                                authenticated. Users will have to be authenticate      3 Facilitate
                                                                when they attempt to use the application, the          management of chronic
                                                                applications themselves must authenticate              conditions 4. Improve
                                                                themselves before accessing EHR information            efficiency 5. Facilitate
                                                                managed by other application or remote EHR             self-health
                                                                Systems. Examples of entity authentication are: •      management 6. Ensure
                                                                Username/ password • Digital certificate • Secure      privacy, confidentiality
                                                                token • Biometrics
I.1.1.2   Entity Authorization      Manage the sets of access-  Users of the EHRS will be allowed to use only the      1. Support delivery of                    E-Essential       R-Required
                                    control permissions granted functions for which they authorized depending on       effective healthcare 2.
                                    to EHRS-Users.              their role, work assignment, location ,etc.            Improve patient safety
                                                                Similarly applications will need to be authorized to   3 Facilitate
                                                                access certain types of EHR data. Financial            management of chronic
                                                                applications will be limited by their role in the      conditions 4. Improve
                                                                types of EHR data they may exchange. For               efficiency 5. Facilitate
                                                                example, authorization functions may control           self-health
                                                                access to EHRS: • Application modules •                management 6. Ensure
                                                                Application features • Data records                    privacy, confidentiality




  Version 7.0                                                                                         page 38 of 144                                          Version Date: 23 February 2004
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HL7         HL7                        HL7                              HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                        EHR                              EHR                                                    EHR                        EHR            Constrainable      Implementable
ID          Function                   Function                         Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
            Name                       Statement                        Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                         CODING             CODING
                                                                                                                                                                         for Ambulatory - for Ambulatory -
                                                                                                                                                                         Outpatient       Outpatient
I.1.1.2.1   Role-Based authorization Authorize access to EHRS           The role of a user is in regards to authorization to   1. Support delivery of                    E-Essential       R-Required
                                     functions and/or data based        access any subject. Examples of EHRS-User roles        effective healthcare 2.
                                     on an entity's role.               include: nurse, dietician, administrator, legal        Improve patient safety
                                                                        guardian, and auditor. Similarly the role of an        3 Facilitate
                                                                        application will determine what types of               management of chronic
                                                                        information in may query, access, or view when         conditions 4. Improve
                                                                        interoperating with complementary applications in      efficiency 5. Facilitate
                                                                        the EHRS.                                              self-health
                                                                                                                               management 6. Ensure
                                                                                                                               privacy, confidentiality




I.1.1.2.2   User-Based authorization Override existing role-based       For example, a doctor may typically be allowed to      1. Support delivery of                    E-Essential       R-Required
                                     and/or context-based               view any patient's record in the Emergency             effective healthcare 2.
                                     authorizations. User-based         Department, except when a patient is also a blood-     Improve patient safety
                                     authorizations restrict or         relative.                                              3 Facilitate
                                     allow an EHRS-user’s access                                                               management of chronic
                                     to a patient’s record                                                                     conditions 4. Improve
                                     (regardless of the user’s role).                                                          efficiency 5. Facilitate
                                                                                                                               self-health
                                                                                                                               management 6. Ensure
                                                                                                                               privacy, confidentiality




  Version 7.0                                                                                                 page 39 of 144                                          Version Date: 23 February 2004
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HL7         HL7                    HL7                             HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                    EHR                             EHR                                                     EHR                        EHR            Constrainable      Implementable
ID          Function               Function                        Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
            Name                   Statement                       Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                     CODING             CODING
                                                                                                                                                                     for Ambulatory - for Ambulatory -
                                                                                                                                                                     Outpatient       Outpatient
I.1.1.2.3   Context-Based          Context-based                   The EHRS must support a set of policies to ensure       1. Support delivery of                    E-Essential       R-Required
            authorization          Authorization– Authorize        that the users can access the information they need     effective healthcare 2.
                                   access to EHRS functions        and they must reference for complete and correct        Improve patient safety
                                   and/or data based on            clinical decision. Context-based authorization          3 Facilitate
                                   geographic, time-related,       extends Role and User-based Authorization by            management of chronic
                                   assignment-related, consent-    overlaying business rules and policies to the user      conditions 4. Improve
                                   related, or other healthcare-   and role. For example, • A nurse may be able to         efficiency 5. Facilitate
                                   related contexts (and           access the EHR’s of patients in the maternity           self-health
                                   according to specific care-     department but not in the neurosurgery                  management 6. Ensure
                                   setting profiles).              department. • A doctor may be able to access a          privacy, confidentiality
                                                                   patient’s EHR before his shift ends, but not after
                                                                   his shift ends. • A dietician may be able to access
                                                                   those parts of a patient’s EHR that impact food-
                                                                   selection, but not other parts of that patient’s EHR.
                                                                   • A physician may not be permitted to access parts
                                                                   of a patient’s EHR that pertain to a civil or
                                                                   criminal matter. • An EHRS-User may only use a
                                                                   patient’s data in a manner consistent with the
                                                                   patient’s (explicit or implied) consent. • A
                                                                   physician may be able to access a given patient’s
                                                                   EHR while providing healthcare, but not while
                                                                   conducting research. • A physician may restrict a
                                                                   patient’s access to the patient’s EHR if the
                                                                   physician believes such access may be harmful to
                                                                   the patient (for example, a suicidal or
I.1.1.4     Secure Data Exchange   Send and receive EHR data       hypochondriac patient).
                                                                   Due to the personal nature of the data, Electronic      1. Support delivery of                    E-Essential       R-Required
                                   securely.                       Health Record information requires security and         effective healthcare 2.
                                                                   privacy considerations that exceed typical              Improve patient safety
                                                                   electronic data security standards.                     3 Facilitate
                                                                                                                           management of chronic
                                                                                                                           conditions 4. Improve
                                                                                                                           efficiency 5. Facilitate
                                                                                                                           self-health
                                                                                                                           management 6. Ensure
                                                                                                                           privacy, confidentiality




  Version 7.0                                                                                            page 40 of 144                                           Version Date: 23 February 2004
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HL7         HL7                   HL7                             HL7                                                       HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                   EHR                             EHR                                                       EHR                        EHR            Constrainable      Implementable
ID          Function              Function                        Functional                                                Rationale                  Secondary      Functional Profile Functional Profile
            Name                  Statement                       Description                                                                          Citation       PRIORITY           REQUIRED
                                                                                                                                                                      CODING             CODING
                                                                                                                                                                      for Ambulatory - for Ambulatory -
                                                                                                                                                                      Outpatient       Outpatient
I.1.1.4.1   Data Obfuscation      Obscure electronically-         Since the EHRS applications cannot control                1. Support delivery of                    EF-Essential Future R-Required
                                  exchanged EHR data to           security of the transmission methods, applications        effective healthcare 2.
                                  inhibit unauthorized data-      must obfuscate the data sent to application within        Improve patient safety
                                  access (according to            the EHRS and particularly to remote entities.             3 Facilitate
                                  applicable healthcare-                                                                    management of chronic
                                  specific rules and relevant                                                               conditions 4. Improve
                                  standards).                                                                               efficiency 5. Facilitate
                                                                                                                            self-health
                                                                                                                            management 6. Ensure
                                                                                                                            privacy, confidentiality

I.1.1.4.2   Secure Data Routing   Route electronically-           EHRS application need to ensure that they are             1. Support delivery of                    E-Essential        R-Required
                                  exchanged EHR data only         exchanging EHR information with the entities              effective healthcare 2.
                                  to/from known, registered,      (applications, institutions, directories) they expect.    Improve patient safety
                                  and authenticated               This function depends on Entity Lookup,                   3 Facilitate
                                  destinations/sources            Authorization, and Authentication to be available         management of chronic
                                  (according to applicable        in the system. For example, a physician practice          conditions 4. Improve
                                  healthcare-specific rules and   management application in the EHRS, might send            efficiency 5. Facilitate
                                  relevant standards).            claim attachment information to an external entity.       self-health
                                                                  For this, the application must use a secure routing       management 6. Ensure
                                                                  method which ensures that both the sender and             privacy, confidentiality
                                                                  receiving sides are authorized to engage in the
                                                                  information exchange.

I.1.1.4.3   Non-repudiation       Limit an EHRS-User’s ability    In general terms, the term "non-repudiation"              1. Support delivery of                    EF-Essential Future R-Required
                                  to deny (repudiate) an          crypto-technically means: In authentication, a            effective healthcare 2.
                                  electronic data-exchange        service that provides proof of the integrity and          Improve patient safety
                                  originated or authorized by     origin of data, both in an unforgeable relationship,      3 Facilitate
                                  that user.                      which can be verified by any third party at any           management of chronic
                                                                  time; or, In authentication, an authentication that       conditions 4. Improve
                                                                  with high assurance can be asserted to be genuine,        efficiency 5. Facilitate
                                                                  and that can not subsequently be refuted. In the          self-health
                                                                  electronic commerce environment, the technical            management 6. Ensure
                                                                  meaning of the term "non-repudiation" either shifts       privacy, confidentiality
                                                                  the onus of proof from the recipient to the alleged
                                                                  signatory or entirely denies the signatory the right
                                                                  to repudiate a digital signature. That is, if a digital
                                                                  signature is verified so as to identify the owner of
                                                                  the private key that was used to create the digital
                                                                  signature in question then it is that person who has
                                                                  the onus of proving that it is not their digital
                                                                  signature. Hence, there is a shift in the burden of
                                                                  proof. This crypto-technical position does not
                                                                  correspond with what occurs in the paper-based
                                                                  environment.



  Version 7.0                                                                                             page 41 of 144                                           Version Date: 23 February 2004
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HL7         HL7                     HL7                             HL7                                                      HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                     EHR                             EHR                                                      EHR                        EHR            Constrainable      Implementable
ID          Function                Function                        Functional                                               Rationale                  Secondary      Functional Profile Functional Profile
            Name                    Statement                       Description                                                                         Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.1.4.4   Data-Exchange Privacy   Limit EHR data                  Communicating the EHR or parts of it to third            1. Support delivery of                    EF-Essential Future R-Required
                                    communications to those         parties that have a legal or other legitimate interest   effective healthcare 2.
                                    explicitly (or implicitly)      in the record should have explicit and documented        Improve patient safety
                                    authorized by the subject-of-   authorization by the patient. Including a clear          3 Facilitate
                                    care or to those that have a    understanding by the third party that the                management of chronic
                                    legal (or other legitimate)     information will only be used for the stated             conditions 4. Improve
                                    need.                           purpose.                                                 efficiency 5. Facilitate
                                                                                                                             self-health
                                                                                                                             management 6. Ensure
                                                                                                                             privacy, confidentiality

I.1.1.5     Patient Privacy         Protect the patient’s privacy   Functionality allows for compliance with personal, 1. Support delivery of                          E-Essential        R-Required
                                    according to personal, local,   local, and national rules.                         effective healthcare 2.
                                    and national rules.                                                                Improve patient safety
                                                                                                                       3 Facilitate
                                                                                                                       management of chronic
                                                                                                                       conditions 4. Improve
                                                                                                                       efficiency 5. Facilitate
                                                                                                                       self-health
                                                                                                                       management 6. Ensure
                                                                                                                       privacy, confidentiality




  Version 7.0                                                                                              page 42 of 144                                           Version Date: 23 February 2004
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HL7         HL7                        HL7                               HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                        EHR                               EHR                                                     EHR                        EHR            Constrainable      Implementable
ID          Function                   Function                          Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
            Name                       Statement                         Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                           CODING             CODING
                                                                                                                                                                           for Ambulatory - for Ambulatory -
                                                                                                                                                                           Outpatient       Outpatient
I.1.1.5.1   Personal patient-privacy   Protect personal privacy          The electronic health record will allow for the         1. Support delivery of                    EF-Essential Future R-Required
            rules                      according to best-practice        assignment, removal, and tracking of anonymous,         effective healthcare 2.
                                       standards.                        de-identified, alias, and restricted access status of   Improve patient safety
                                                                         protected health information. For example: • Make       3 Facilitate
                                                                         anonymize, de-identify, or apply alias to EHR data      management of chronic
                                                                         provided for public health, clinical research, and      conditions 4. Improve
                                                                         population health initiatives. Re-identify specific     efficiency 5. Facilitate
                                                                         data in special cases (e.g., disease-outbreak           self-health
                                                                         detection). • Include or exclude a subject-of-care’s    management 6. Ensure
                                                                         data for specific purposes (such as for research or     privacy, confidentiality
                                                                         public health initiatives). An example of "best-
                                                                         practice standard" would be the HIPAA Privacy
                                                                         Rule which requires that covered providers
                                                                         communicate only the minimum necessary
                                                                         information about a patient for payment or
                                                                         operations. With respect to HIPAA transactions, a
                                                                         covered provider may only transmit situational
                                                                         data elements when these are required by a
                                                                         condition stated in the transaction implementation
                                                                         guide. In addition, a covered provider can only
                                                                         communicate the minimum necessary information
                                                                         needed for operations purposes such as quality-
                                                                         related health care activities or fraud and abuse
                                                                         detection.

I.1.1.5.2   Local and National         Support mechanisms for            The electronic health record will allow for the         1. Support delivery of                    EF-Essential Future R-Required
            patient-privacy rules      implementing (codifying),         compliance with realm-specific privacy rules. An        effective healthcare 2.
                                       validating, and displaying        example of such rule is the HIPAA Privacy Rule          Improve patient safety
                                       local and national (realm-)       which gives patients the right to request               3 Facilitate
                                       specific privacy rules. The       suppression of their health care information under      management of chronic
                                       rules defining patient privacy    circumstances such as domestic violence. If the         conditions 4. Improve
                                       requirements will be codified     provider agrees to do this, then the provider must      efficiency 5. Facilitate
                                       in the EHRS. These rules          ensure that the patient's protected health              self-health
                                       will be used by EHRS              information is not disclosed per this agreement.        management 6. Ensure
                                       applications to ensure that       Some states have more stringent laws that preempt       privacy, confidentiality
                                       the privacy level defined for     HIPAA. For example, in some states, patients, who
                                       the patient is maintained (for    are minors, have a right to suppress protected
                                       example, at the                   health information related to sensitive services
                                       jurisdictional, organizational,   such as treatment for reproductive health, mental
                                       or patient-specified level).      health, and substance abuse.




  Version 7.0                                                                                                   page 43 of 144                                          Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                      DoD EHR - HL7 EHR Mapping                                           HL7 EHR-S Profile Coding
HL7         HL7                     HL7                           HL7                                               HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                     EHR                           EHR                                               EHR                        EHR            Constrainable      Implementable
ID          Function                Function                      Functional                                        Rationale                  Secondary      Functional Profile Functional Profile
            Name                    Statement                     Description                                                                  Citation       PRIORITY           REQUIRED
                                                                                                                                                              CODING             CODING
                                                                                                                                                              for Ambulatory - for Ambulatory -
                                                                                                                                                              Outpatient       Outpatient
I.1.1.5.3   Advisement of Patient   Record that the patient was   The EHRS will allow for the dispensing and        1. Support delivery of                    EF-Essential Future R-Required
            Privacy Rights          informed of current privacy   tracking of patient education regarding current   effective healthcare 2.
                                    policies practices.           privacy policies and procedures.                  Improve patient safety
                                                                                                                    3 Facilitate
                                                                                                                    management of chronic
                                                                                                                    conditions 4. Improve
                                                                                                                    efficiency 5. Facilitate
                                                                                                                    self-health
                                                                                                                    management 6. Ensure
                                                                                                                    privacy, confidentiality




  Version 7.0                                                                                          page 44 of 144                                      Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                     DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7       HL7                     HL7                            HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                     EHR                            EHR                                                     EHR                        EHR            Constrainable      Implementable
ID        Function                Function                       Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
          Name                    Statement                      Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                   CODING             CODING
                                                                                                                                                                   for Ambulatory - for Ambulatory -
                                                                                                                                                                   Outpatient       Outpatient
I.1.2     Health Record
          Information &
          Management
I.1.2.0   EHR Information         Manage the EHR                 Electronic Health Record information will be            1. Support delivery of                    E-Essential       R-Required
          Management (Record      information across EHRS        available on a variety of EHRS applications. The        effective healthcare 2.
          Management)             applications                   EHRS must provide the ability for users to access       Improve patient safety
                                                                 this information, to manage it, to control access to    3 Facilitate
                                                                 it, and to audit the use and access of data.            management of chronic
                                                                                                                         conditions 4. Improve
                                                                                                                         efficiency 5. Facilitate
                                                                                                                         self-health
                                                                                                                         management 6. Ensure
                                                                                                                         privacy, confidentiality




I.1.2.1   Information Integrity   Ensure that clinical           An important aspect of maintaining a legally sound      1. Support delivery of                    E-Essential       R-Required
                                  information is valid           health record is securing the record to prevent loss,   effective healthcare 2.
                                  according to the healthcare-   tampering, or unauthorized use. The integrity of        Improve patient safety
                                  specific business rules.       the health record may be questioned in a legal          3 Facilitate
                                                                 proceeding if concerns are raised about the             management of chronic
                                                                 security of paper-based or electronic records. The      conditions 4. Improve
                                                                 Rules of Evidence require an organization to have       efficiency 5. Facilitate
                                                                 policies and procedures in place to protect against     self-health
                                                                 alterations, tampering, and loss. Systems and           management 6. Ensure
                                                                 procedures should also be in place to prevent loss      privacy, confidentiality
                                                                 (such as tracking and sign-out procedures), secure
                                                                 record storage areas or systems, and limit access to
                                                                 only authorized users. For example, • Entered data
                                                                 must be validated based on system edit rules and
                                                                 valid code sets. These may be field specific (i.e.
                                                                 valid list of values), intra-record (i.e. date
                                                                 deceased) date of birth), or they may extend across
                                                                 multiple related records (i.e. test order must exist
                                                                 before test results can be recorded). • Healthcare
                                                                 documents must not be altered as dictated by the
                                                                 “Uniform Rules of Evidence” and the ”Federal
                                                                 Rules of Evidence”. • Translations between
                                                                 numbering systems and written languages must not
                                                                 result in substantive document alterations.




  Version 7.0                                                                                          page 45 of 144                                           Version Date: 23 February 2004
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HL7       HL7                    HL7                             HL7                                                   HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                    EHR                             EHR                                                   EHR                        EHR            Constrainable      Implementable
ID        Function               Function                        Functional                                            Rationale                  Secondary      Functional Profile Functional Profile
          Name                   Statement                       Description                                                                      Citation       PRIORITY           REQUIRED
                                                                                                                                                                 CODING             CODING
                                                                                                                                                                 for Ambulatory - for Ambulatory -
                                                                                                                                                                 Outpatient       Outpatient
I.1.2.2   Document Retention     Retain all clinical documents   Each healthcare provider should develop a             1. Support delivery of                    E-Essential        R-Required
                                 (including complex              retention schedule for patient health information     effective healthcare 2.
                                 standards-based clinical        that meets the needs of its patients, physicians,     Improve patient safety
                                 documents) for the policy-      researchers, and other legitimate users, and          3 Facilitate
                                 designated or legally-          complies with legal, regulatory, and accreditation    management of chronic
                                 designated time period.         requirements. EHRS applications must conform to       conditions 4. Improve
                                                                 the current rules.                                    efficiency 5. Facilitate
                                                                                                                       self-health
                                                                                                                       management 6. Ensure
                                                                                                                       privacy, confidentiality




I.1.2.3   Inbound Documents      Retain inbound documents as An important aspect of maintaining a legally sound        1. Support delivery of                    EF-Essential Future R-Required
                                 received (unaltered).       health record is securing the record to prevent loss,     effective healthcare 2.
                                                             tampering, or unauthorized use. The integrity of          Improve patient safety
                                                             the health record may be questioned in a legal            3 Facilitate
                                                             proceeding if concerns are raised about the               management of chronic
                                                             security of the electronic health record. Therefore       conditions 4. Improve
                                                             when clinical documents are exchanged by EHRS             efficiency 5. Facilitate
                                                             applications, the receiving application is expected       self-health
                                                             to retain inbound documents unchanged.                    management 6. Ensure
                                                                                                                       privacy, confidentiality




I.1.2.4   Document Attestation   Support electronic attestation The purpose of authentication is to show               1. Support delivery of                    E-Essential        R-Required
                                 of documents.                  authorship and assign responsibility for an act,       effective healthcare 2.
                                                                event, condition, opinion, or diagnosis. Every entry   Improve patient safety
                                                                in the health record must be authenticated by the      3 Facilitate
                                                                author and should not be made or signed by             management of chronic
                                                                someone other than the author. This includes all       conditions 4. Improve
                                                                types of entries such as narrative/progress notes,     efficiency 5. Facilitate
                                                                assessments, flow sheets, orders, etc., whether in     self-health
                                                                paper or electronic format. For example, digital       management 6. Ensure
                                                                signatures may be used to implement document           privacy, confidentiality
                                                                attestation for EHR.




  Version 7.0                                                                                         page 46 of 144                                          Version Date: 23 February 2004
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HL7         HL7                     HL7                               HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                     EHR                               EHR                                                    EHR                        EHR            Constrainable      Implementable
ID          Function                Function                          Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
            Name                    Statement                         Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.2.4.1   Retention of Document   Retain the signature of           For example, retain a digital signature that was       1. Support delivery of                    EF-Essential Future R-Required
            Attestation             attestation (or certificate of    included with an inbound clinical document.            effective healthcare 2.
                                    authenticity) associated with                                                            Improve patient safety
                                    an incoming or outgoing                                                                  3 Facilitate
                                    document.                                                                                management of chronic
                                                                                                                             conditions 4. Improve
                                                                                                                             efficiency 5. Facilitate
                                                                                                                             self-health
                                                                                                                             management 6. Ensure
                                                                                                                             privacy, confidentiality




I.1.2.5     Confidentiality         Promote patient                   This section deals with the enforcements of the        1. Support delivery of                    E-Essential        R-Required
                                    confidentiality by enforcing      privacy rules. Patients may be harmed if their         effective healthcare 2.
                                    the privacy rules that apply to   privacy is invaded (including unauthorized access      Improve patient safety
                                    various parts of the EHR.         to Electronic Healthcare Records), or if the patient   3 Facilitate
                                                                      a part of their records that they must not access or   management of chronic
                                                                      view.                                                  conditions 4. Improve
                                                                                                                             efficiency 5. Facilitate
                                                                                                                             self-health
                                                                                                                             management 6. Ensure
                                                                                                                             privacy, confidentiality




  Version 7.0                                                                                               page 47 of 144                                          Version Date: 23 February 2004
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HL7         HL7                       HL7                              HL7                                                      HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                       EHR                              EHR                                                      EHR                        EHR            Constrainable      Implementable
ID          Function                  Function                         Functional                                               Rationale                  Secondary      Functional Profile Functional Profile
            Name                      Statement                        Description                                                                         Citation       PRIORITY           REQUIRED
                                                                                                                                                                          CODING             CODING
                                                                                                                                                                          for Ambulatory - for Ambulatory -
                                                                                                                                                                          Outpatient       Outpatient
I.1.2.5.1   Protection of Patient     Provide the mechanisms to        The EHRS must provide EHR confidentiality-               1. Support delivery of                    E-Essential       R-Required
            Privacy                   implement adherence to the       controls that minimize each type of harm. This           effective healthcare 2.
                                      patient privacy rules codified   function requires that the EHRS implement                Improve patient safety
                                      in the EHR Information           mechanisms to protect the confidentiality of the         3 Facilitate
                                      Security subsection of the       Electronic Health Record in a consistent way by          management of chronic
                                      Information Infrastructure       enforcing rules and policies defined by the best-        conditions 4. Improve
                                      section of this document.        practice standards and governmental organization.        efficiency 5. Facilitate
                                                                       EHR Information Security controls differ for             self-health
                                                                       various care-settings. The EHR Information               management 6. Ensure
                                                                       Security subsection of the Information                   privacy, confidentiality
                                                                       Infrastructure section of this document details
                                                                       those controls. For example, to comply with
                                                                       HIPAA Privacy Rule requirement that a covered
                                                                       provider only transmit situational data that is
                                                                       required under certain conditions, the provider or
                                                                       its billing service/clearinghouse, must have edits in
                                                                       place in the systems that process transactions that
                                                                       ensure this requirement is met. In order to support
                                                                       administrative and financial reporting in Section
                                                                       6.3.0.0, the EHR must collect data necessary for
                                                                       the transaction processing systems to support this
                                                                       requirement. Consider also a patient who is
                                                                       suffering physical abuse by a guardian. If the
                                                                       guardian reads certain portions of the provider's
                                                                       notes, the patient might be further endangered.
I.1.2.5.2   Restrict Patient Access   Enable a healthcare              Although patient mightthe right to view much of
                                                                       Finally, a a patient has not even confide in the         1. Support delivery of                    E-Essential       R-Required
                                      professional to restrict a       his/her Electronic Healthcare Record, a healthcare       effective healthcare 2.
                                      patient’s access to EHR data     provider sometimes needs to prevent a patient (or        Improve patient safety
                                      that is potentially harmful to   guardian) from viewing parts of the record.              3 Facilitate
                                      the patient/subject-of-care.     Consider, for example, a patient receiving               management of chronic
                                                                       psychiatric care: the patient might harm himself         conditions 4. Improve
                                                                       (or others) if he reads the doctor's evaluation of his   efficiency 5. Facilitate
                                                                       condition. Furthermore, reading the doctor's             self-health
                                                                       therapy-plan might actually cause the plan to fail.      management 6. Ensure
                                                                                                                                privacy, confidentiality




  Version 7.0                                                                                                 page 48 of 144                                           Version Date: 23 February 2004
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HL7         HL7                      HL7                               HL7                                                   HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                      EHR                               EHR                                                   EHR                        EHR            Constrainable      Implementable
ID          Function                 Function                          Functional                                            Rationale                  Secondary      Functional Profile Functional Profile
            Name                     Statement                         Description                                                                      Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.2.6     Audit trail              Track changes to EHR data         Most information systems benefit from the quality     1. Support delivery of                    E-Essential       R-Required
                                     to verify enforcement of          control offered by an audit trail. All systems that   effective healthcare 2.
                                     business, security, and access-   are backed up, for example, also note the date and    Improve patient safety
                                     control rules.                    time of the backup in an audit log. Healthcare-       3 Facilitate
                                                                       related information systems, however, have many       management of chronic
                                                                       additional events and controls that must be audited   conditions 4. Improve
                                                                       (tracked) due to the sensitive (personal) nature of   efficiency 5. Facilitate
                                                                       the healthcare data itself. For example: HIPAA        self-health
                                                                       Security Rule Section 164.308(a)(1)(i) Security       management 6. Ensure
                                                                       Management Process requires Information System        privacy, confidentiality
                                                                       Activity Review, which means to "Implement
                                                                       procedures to regularly review records of
                                                                       information system activity, such as audit logs,
                                                                       access reports, and security incident tracking
                                                                       reports."

I.1.2.6.1   Amendment history        Track amendments to               Once an clinical document receives a mark of          1. Support delivery of                    E-Essential       R-Required
                                     clinical documents.               attestation by a healthcare provider, (e.g., a        effective healthcare 2.
                                                                       signature), it becomes a legal document and must      Improve patient safety
                                                                       be preserved in an unaltered fashion. Sometimes,      3 Facilitate
                                                                       however, corrections or amendments need to be         management of chronic
                                                                       made to the document. In these cases, the EHRS        conditions 4. Improve
                                                                       must keep track of the corrections or amendments      efficiency 5. Facilitate
                                                                       such that the integrity of the original (signed)      self-health
                                                                       document is still preserved.                          management 6. Ensure
                                                                                                                             privacy, confidentiality




I.1.2.6.2   Information Lifecycle    Track who, when, and by        The EHRS application must be able to record              1. Support delivery of                    E-Essential       R-Required
            Alteration-Event audit   which system an EHR record information required to determine who altered                effective healthcare 2.
                                     was created, updated,          EHR related information in that application.             Improve patient safety
                                     translated or (if local policy                                                          3 Facilitate
                                     permits) deleted.                                                                       management of chronic
                                                                                                                             conditions 4. Improve
                                                                                                                             efficiency 5. Facilitate
                                                                                                                             self-health
                                                                                                                             management 6. Ensure
                                                                                                                             privacy, confidentiality




  Version 7.0                                                                                               page 49 of 144                                          Version Date: 23 February 2004
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HL7         HL7                     HL7                            HL7                                                       HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                     EHR                            EHR                                                       EHR                        EHR            Constrainable      Implementable
ID          Function                Function                       Functional                                                Rationale                  Secondary      Functional Profile Functional Profile
            Name                    Statement                      Description                                                                          Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.2.6.3   Information Lifecycle   Track who, when, and by    The EHRS application must be able to record                   1. Support delivery of                    E-Essential       R-Required
            Access-Event audit      which system an EHR record information required to determine who viewed or               effective healthcare 2.
                                    was viewed or extracted.   extracted EHR related information from that                   Improve patient safety
                                                               application.                                                  3 Facilitate
                                                                                                                             management of chronic
                                                                                                                             conditions 4. Improve
                                                                                                                             efficiency 5. Facilitate
                                                                                                                             self-health
                                                                                                                             management 6. Ensure
                                                                                                                             privacy, confidentiality




I.1.2.6.4   Record audit            Generate an audit report for   Differing care-settings benefit from being able to        1. Support delivery of                    E-Essential       R-Required
                                    an EHR record (or for a set    identity the various people or systems that viewed        effective healthcare 2.
                                    of EHR records).               or altered a patient's (or set of patient's) EHR's. For   Improve patient safety
                                                                   example, a judge might want to know how many              3 Facilitate
                                                                   patients a given healthcare provider treated while        management of chronic
                                                                   the provider's license was suspended. Similarly, in       conditions 4. Improve
                                                                   some cases a report detailing all those who               efficiency 5. Facilitate
                                                                   modified or viewed a certain patient record might         self-health
                                                                   be needed.                                                management 6. Ensure
                                                                                                                             privacy, confidentiality




  Version 7.0                                                                                              page 50 of 144                                           Version Date: 23 February 2004
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HL7         HL7                    HL7                           HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                    EHR                           EHR                                                    EHR                        EHR            Constrainable      Implementable
ID          Function               Function                      Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
            Name                   Statement                     Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                  CODING             CODING
                                                                                                                                                                  for Ambulatory - for Ambulatory -
                                                                                                                                                                  Outpatient       Outpatient
I.1.2.6.5   Security audit         Track and summarize           Often, clinical information is considered to be        1. Support delivery of                    E-Essential        R-Required
                                   attempts by unauthorized      sensitive to the subject-of-care and therefore must    effective healthcare 2.
                                   users to access EHR           be secured. (An example of a care-setting where        Improve patient safety
                                   information.                  clinical information may not necessarily be            3 Facilitate
                                                                 sensitive to the subject-of-care is veterinary         management of chronic
                                                                 medicine.) In addition to actually securing the        conditions 4. Improve
                                                                 EHR data itself, an EHRS must also be able to          efficiency 5. Facilitate
                                                                 prove that it secured the EHR data. A security         self-health
                                                                 audit trail can help provide such proof. In large      management 6. Ensure
                                                                 healthcare settings, EHRS' typically log not only      privacy, confidentiality
                                                                 accesses to sensitive EHR data, but attempts to
                                                                 access EHR data by unauthorized users. The level
                                                                 of auditing (detail) required can range anywhere
                                                                 from a local policy to a national standard -- as
                                                                 appropriate to each care-setting. Tracking the
                                                                 attempts of unauthorized users to access sensitive
                                                                 EHR information will enable healthcare
                                                                 organizations to identify the staff members who
                                                                 are not following the local patient privacy rules.

I.1.2.6.6   Information-Exchange   Retain any information        If EHR information is exchanged between EHRS           1. Support delivery of                    EF-Essential Future R-Required
            audit                  exchange details along with   application for viewing or other purposes, the         effective healthcare 2.
                                   any amendment history sent    receiving application must log information about       Improve patient safety
                                   with clinical documents by    the sender and the nature, history, and content of     3 Facilitate
                                   an external clinical or EHR   the information exchanged in the transaction If any    management of chronic
                                   system.                       translations are necessary (.e.g. vocabulary lookup)   conditions 4. Improve
                                                                 then a record of the transformation must be created    efficiency 5. Facilitate
                                                                 by the receiving application. For example, in          self-health
                                                                 addition to receiving an EHR from an external          management 6. Ensure
                                                                 system, receive the amendment history for that         privacy, confidentiality
                                                                 record, the identity of the originating system, and
                                                                 details about the receiving system’s reception
                                                                 event (including, when and by whom the EHR and
                                                                 its audit trail were received).




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HL7         HL7                        HL7                            HL7                                                      HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                        EHR                            EHR                                                      EHR                        EHR            Constrainable      Implementable
ID          Function                   Function                       Functional                                               Rationale                  Secondary      Functional Profile Functional Profile
            Name                       Statement                      Description                                                                         Citation       PRIORITY           REQUIRED
                                                                                                                                                                         CODING             CODING
                                                                                                                                                                         for Ambulatory - for Ambulatory -
                                                                                                                                                                         Outpatient       Outpatient
I.1.2.6.7   Business-Rule audit        Audit compliance of (and       Clinical decision-support rules and administrative       1. Support delivery of                    EF-Essential Future R-Required
                                       overrides to) decision-        (business) decision-support rules are designed to        effective healthcare 2.
                                       support business rules.        help the healthcare provider make good, timely,          Improve patient safety
                                                                      efficient, and cost-effective medical and workflow-      3 Facilitate
                                                                      related decisions. An audit trail provides evidence      management of chronic
                                                                      of the healthcare provider's adherence with those        conditions 4. Improve
                                                                      various rules. Since each healthcare setting             efficiency 5. Facilitate
                                                                      requires differing sets of rules, corresponding audit    self-health
                                                                      trail requirements will be different for each setting.   management 6. Ensure
                                                                      For example, in a large hospital a doctor might be       privacy, confidentiality
                                                                      expected to deliver control of a patient to another
                                                                      doctor before leaving the hospital when her shift is
                                                                      finished. An corresponding audit trail would
                                                                      indicate whether this rule was followed. A small
                                                                      healthcare practice might have no such rule (and
                                                                      no need for a corresponding audit trail).



I.1.2.7     Data Archival and Storage Persist long-term EHR          The EHRS application must provide facilities to           1. Support delivery of                    E-Essential        R-Required
                                      information according to best- achieve clinical (EHR-related) information.               effective healthcare 2.
                                      practice standards.            Example of best-practices standards: HIPAA                Improve patient safety
                                                                     Security Rule Section 164.308(a)(7)(i)                    3 Facilitate
                                                                     Administrative Safeguards - Data Backup Plan              management of chronic
                                                                     (Required): "Establish and implement procedures           conditions 4. Improve
                                                                     to create and maintain retrievable exact copies of        efficiency 5. Facilitate
                                                                     electronic protected health information."                 self-health
                                                                                                                               management 6. Ensure
                                                                                                                               privacy, confidentiality




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HL7         HL7                  HL7                               HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                  EHR                               EHR                                                    EHR                        EHR            Constrainable      Implementable
ID          Function             Function                          Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
            Name                 Statement                         Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                    CODING             CODING
                                                                                                                                                                    for Ambulatory - for Ambulatory -
                                                                                                                                                                    Outpatient       Outpatient
I.1.2.7.1   Persisted EHR data   Archive and retrieve              Paper-based healthcare records are difficult to        1. Support delivery of                    E-Essential       R-Required
                                 information to/from diverse       view. An electronic implementation of a paper-         effective healthcare 2.
                                 technology storage devices        based system can be just as cumbersome to view.        Improve patient safety
                                 based on availability             Therefore, in order for the electronic version of a    3 Facilitate
                                 requirements for specific         healthcare records to prove beneficial, the EHR        management of chronic
                                 data (according to clinical or    must be archived and retrieved in a semantically       conditions 4. Improve
                                 administrative business rules).   intelligent and useful manner. A database of           efficiency 5. Facilitate
                                                                   clinical and administrative business rules will help   self-health
                                                                   present Electronic Health Records to the various       management 6. Ensure
                                                                   EHR-viewers in efficient and intelligent ways --       privacy, confidentiality
                                                                   fulfilling the promise of enhanced access. As
                                                                   technology changes, the means by which the stored
                                                                   data is presented can also change, taking
                                                                   advantage of the particular strengths of each new
                                                                   device. This function requires that information no
                                                                   longer needed by operational EHRS application is
                                                                   persisted (either for ever or for a pre-defined
                                                                   period of time) using appropriate technology and
                                                                   policies to support the business requirements of
                                                                   the EHR. The EHRS must be able to retrieve and
                                                                   allow users to view persisted EHR data.




  Version 7.0                                                                                            page 53 of 144                                          Version Date: 23 February 2004
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HL7         HL7                        HL7                               HL7                                                       HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                        EHR                               EHR                                                       EHR                        EHR            Constrainable      Implementable
ID          Function                   Function                          Functional                                                Rationale                  Secondary      Functional Profile Functional Profile
            Name                       Statement                         Description                                                                          Citation       PRIORITY           REQUIRED
                                                                                                                                                                             CODING             CODING
                                                                                                                                                                             for Ambulatory - for Ambulatory -
                                                                                                                                                                             Outpatient       Outpatient
I.1.2.7.2   Retrospective EHR          Access EHR data                   The EHRS will be able to reconstruct the patient          1. Support delivery of                    E-Essential       R-Required
                                       chronologically, archived for     record in its totality across time and across             effective healthcare 2.
                                       the lifetime of the subject-of-   providers. The EHRS applications will present a           Improve patient safety
                                       care. Timestamp notable           view of this data to the clinicians. When Electronic      3 Facilitate
                                       healthcare-related points in      Health Records are organized in chronological             management of chronic
                                       time (such as time of arrival,    order, a healthcare provider can more easily locate       conditions 4. Improve
                                       time of record-review, time       significant healthcare events and begin to construct      efficiency 5. Facilitate
                                       of physical examination, or       a basis on which to make informed medical                 self-health
                                       time of elopement).               decisions. A provider will typically desire to view       management 6. Ensure
                                                                         a list of previous visits and the reasons for those       privacy, confidentiality
                                                                         visits in reverse (i.e., latest first) chronological
                                                                         order. By capturing timestamps of notable
                                                                         healthcare-related events (such as time of arrival,
                                                                         time of record-review, or time of physical
                                                                         examination), a healthcare provider can quickly
                                                                         determine when a patient's last visit occurred,
                                                                         when he last reviewed a patient's record, or how
                                                                         long it has been since the patient's last physical
                                                                         examination. For example, chronological lists of
                                                                         previous visits and the reasons for visits, the ability
                                                                         to review progress notes easily in reverse
                                                                         chronological (latest first) order.



I.1.2.7.3   (Legally proscribed) Data Archive (and make                  Different care-settings often require differing           1. Support delivery of                    E-Essential       R-Required
            Retention                 accessible) the EHR for the        periods of EHR retention (after which the data has        effective healthcare 2.
                                      period of time required by         little or no value). Since the cost and speed of          Improve patient safety
                                      law (typically five years from     various data storage technologies also varies,            3 Facilitate
                                      the time the care was              archival of EHR data can be managed (balanced)            management of chronic
                                      rendered).                         in such a way as to minimize costs while still            conditions 4. Improve
                                                                         meeting data access needs.                                efficiency 5. Facilitate
                                                                                                                                   self-health
                                                                                                                                   management 6. Ensure
                                                                                                                                   privacy, confidentiality




  Version 7.0                                                                                                    page 54 of 144                                           Version Date: 23 February 2004
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HL7         HL7                 HL7                             HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                 EHR                             EHR                                                     EHR                        EHR            Constrainable      Implementable
ID          Function            Function                        Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
            Name                Statement                       Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                  CODING             CODING
                                                                                                                                                                  for Ambulatory - for Ambulatory -
                                                                                                                                                                  Outpatient       Outpatient
I.1.2.7.4   Data Availability   Make clinical information      Not only must clinical information be available for      1. Support delivery of                    E-Essential       R-Required
                                readily available (as required recall, in certain care-settings the data must also be   effective healthcare 2.
                                by a clinical care setting).   available within a proscribed period of time. For        Improve patient safety
                                                               example, if the EHRS fails to present a report that      3 Facilitate
                                                               it has received from a laboratory in a timely            management of chronic
                                                               fashion, the patient may die. Depending on the           conditions 4. Improve
                                                               care setting, the EHRS must make all or some of          efficiency 5. Facilitate
                                                               the EHR information available when, where, and           self-health
                                                               how the users need it.                                   management 6. Ensure
                                                                                                                        privacy, confidentiality




  Version 7.0                                                                                         page 55 of 144                                           Version Date: 23 February 2004
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HL7       HL7                  HL7                              HL7                                                   HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                  EHR                              EHR                                                   EHR                        EHR            Constrainable      Implementable
ID        Function             Function                         Functional                                            Rationale                  Secondary      Functional Profile Functional Profile
          Name                 Statement                        Description                                                                      Citation       PRIORITY           REQUIRED
                                                                                                                                                                CODING             CODING
                                                                                                                                                                for Ambulatory - for Ambulatory -
                                                                                                                                                                Outpatient       Outpatient
I.1.3     Unique Identity,
          Registry, and
          Directory Services
I.1.3.0   Chain of Custody     Track specimens,                 Chain of Custody is necessary for laboratory          1. Support delivery of                    EF-Essential Future R-Required
                               pharmaceuticals, and other       evidence involving the subset of cases that, for      effective healthcare 2.
                               materials from the subject-of-   example, include: criminal, family court,             Improve patient safety
                               care to the receiving party as   protective services, insurance fraud, and liability   3 Facilitate
                               required by business rules.      cases. Chain of custody support can be                management of chronic
                                                                accomplished either by supplying necessary            conditions 4. Improve
                                                                information to an external system that is             efficiency 5. Facilitate
                                                                responsible for tracking chain of custody, or by      self-health
                                                                supporting chain of custody within the EHRS.          management 6. Ensure
                                                                Chain of custody functions within an EHRS will        privacy, confidentiality
                                                                be necessary for those organizations that use local
                                                                office laboratories that lack formal laboratory
                                                                information management systems.




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HL7       HL7                        HL7                            HL7                                                      HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                        EHR                            EHR                                                      EHR                        EHR            Constrainable      Implementable
ID        Function                   Function                       Functional                                               Rationale                  Secondary      Functional Profile Functional Profile
          Name                       Statement                      Description                                                                         Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.4     Support for Health
          Informatics and
          Terminology Standards

I.1.4.0   Unique Identity, Registry, Identify and/or lookup         These functions are critical to successfully             1. Support delivery of                    EF-Essential Future R-Required
          and Directory              subjects-of-care, providers,   managing the security, interoperability and the          effective healthcare 2.
                                     payers, employers, material    consistently of the EHR data across the EHR-             Improve patient safety
                                     resources, and references to   System.                                                  3 Facilitate
                                     various parts of the EHR                                                                management of chronic
                                     (hosted locally and/or                                                                  conditions 4. Improve
                                     remotely).                                                                              efficiency 5. Facilitate
                                                                                                                             self-health
                                                                                                                             management 6. Ensure
                                                                                                                             privacy, confidentiality




I.1.4.1   Inter-registry             Obscure electronically-        This function recognizes that the EHRS will rely         1. Support delivery of                    EF-Essential Future R-Required
          communication              exchanged EHR data to          on an set of infrastructure services, directories, and   effective healthcare 2.
                                     inhibit unauthorized data-     registries organized hierarchically. Additionally,       Improve patient safety
                                     access (according to           this function assumes that the EHR Systems will          3 Facilitate
                                     applicable healthcare-         need to communicate with each other. For                 management of chronic
                                     specific rules and relevant    example: if a patient is treated at the primary care     conditions 4. Improve
                                     standards).                    physician for a chronic condition but becomes ill        efficiency 5. Facilitate
                                                                    while visiting a different region, the new provider      self-health
                                                                    will lookup the patient and in, the background, the      management 6. Ensure
                                                                    EHRS at the remote site will have to interrogate a       privacy, confidentiality
                                                                    local, regional, and even a nation registry to find
                                                                    the match. With the patient identify, the remote
                                                                    EHRS will interrogate the primary care physician's
                                                                    EHRS for information relevant to the new episode
                                                                    of care, in conformance with the applicable patient
                                                                    privacy and confidentiality rules. An example of
                                                                    using a local registry would be that of an EHRS
                                                                    application sending a query message to the
                                                                    Hospital Information System to retrieve a patient
                                                                    demographics.




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HL7       HL7                       HL7                              HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                       EHR                              EHR                                                     EHR                        EHR            Constrainable      Implementable
ID        Function                  Function                         Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
          Name                      Statement                        Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.4.2   Entity Identity Lookup    The EHRS applications must       In order to create a correct and complete               1. Support delivery of                    EF-Essential Future R-Required
          for Clinical Functions    be able to utilize a registry    Electronic Health Record, the EHRS applications         effective healthcare 2.
                                    service to uniquely identify     must ensure that they are consistently referencing      Improve patient safety
                                    and retrieve information for     Subjects of Care (patients, clients) and Providers.     3 Facilitate
                                    existing records of healthcare   This function requires that EHRS Applications           management of chronic
                                    delivery stakeholders: •         transparently invoke algorithms for uniquely            conditions 4. Improve
                                    Subjects of care • Providers     identifying a certain Subject of Care or a Provider.    efficiency 5. Facilitate
                                                                     This way, the applications will be able to retrieve     self-health
                                                                     patient demographic, provider identity and              management 6. Ensure
                                                                     certification information, etc.                         privacy, confidentiality

I.1.4.3   Entity Identity Lookup    The EHRS applications must       In order to support financial functions, the EHRS       1. Support delivery of                    EF-Essential Future R-Required
          for Financial Functions   be able to utilize a registry    application must be able to retrieve information        effective healthcare 2.
                                    service to uniquely identify     about payors. Note that updating financial              Improve patient safety
                                    and retrieve information for     stakeholder registry records is not in the scope of     3 Facilitate
                                    existing records of financial    the EHRS. EHRS application will be enabled only         management of chronic
                                    stakeholders: • Payors           to lookup this information not update it. An            conditions 4. Improve
                                    (Insurers) • Employers           example of lookup would be looking up Payor             efficiency 5. Facilitate
                                                                     information for determining the eligibility of a        self-health
                                                                     Subject of Care.                                        management 6. Ensure
                                                                                                                             privacy, confidentiality




I.1.4.4   Entity Identity         Limit EHR data                     The ability to update the contents of identity          1. Support delivery of                    EF-Essential Future R-Required
          Management for Clinical communications to those            directories ( for Subject of Care and Providers)        effective healthcare 2.
          Functions               explicitly (or implicitly)         ensures that the information in those directories       Improve patient safety
                                  authorized by the subject-of-      stays current over time. EHRS applications must         3 Facilitate
                                  care or to those that have a       be able to update the information, if needed.           management of chronic
                                  legal (or other legitimate)        Examples of identity management operations are:         conditions 4. Improve
                                  need.                              update existing record, link registry records for       efficiency 5. Facilitate
                                                                     same patient, unlink registry records previously        self-health
                                                                     linked in error, delete record, etc. The EHRS must      management 6. Ensure
                                                                     also handle the update notifications from the           privacy, confidentiality
                                                                     registry to those application who registered interest
                                                                     in a certain record.




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HL7       HL7                    HL7                                HL7                                                   HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                    EHR                                EHR                                                   EHR                        EHR            Constrainable      Implementable
ID        Function               Function                           Functional                                            Rationale                  Secondary      Functional Profile Functional Profile
          Name                   Statement                          Description                                                                      Citation       PRIORITY           REQUIRED
                                                                                                                                                                    CODING             CODING
                                                                                                                                                                    for Ambulatory - for Ambulatory -
                                                                                                                                                                    Outpatient       Outpatient
I.1.4.5   Entity Access Lookup   Verify and enforce access          This is a fundamental function of EHRS                1. Support delivery of                    E-Essential        R-Required
                                 control (authentication and        applications. These applications are expected to      effective healthcare 2.
                                 authorization) permissions to      use algorithms for uniquely identifying entities      Improve patient safety
                                 EHR information for end-           (users, applications, etc.) when they attempt to      3 Facilitate
                                 users, applications, sites, etc.   access EHR data. To ensure the access control, the    management of chronic
                                                                    EHRS applications will perform an identity lookup     conditions 4. Improve
                                                                    of users or application for any operations that       efficiency 5. Facilitate
                                                                    require it (authentication, access control, secure    self-health
                                                                    routing, querying, etc.).                             management 6. Ensure
                                                                                                                          privacy, confidentiality




I.1.4.6   EHR Key Directory      The EHRS must maintain             As EHR information will be persisted across           1. Support delivery of                    E-Essential        R-Required
                                 and use a directory of keys        EHRS applications and archives, a directory of        effective healthcare 2.
                                 which link related records         pointers to the various parts of the EHR will be      Improve patient safety
                                 across the applications that       required in order to retrieve the entire record or    3 Facilitate
                                 constitute the EHR. This           selected parts of the EHR.                            management of chronic
                                 directory will be necessary to                                                           conditions 4. Improve
                                 access the various                                                                       efficiency 5. Facilitate
                                 components of the EHR                                                                    self-health
                                 across local (e.g. Master                                                                management 6. Ensure
                                 Patient Index), regional,                                                                privacy, confidentiality
                                 jurisdictional, national, or
                                 international boundaries.

I.1.4.7   Clinical Registries    Access and submit update           Clinical registries provide an aggregate view or      1. Support delivery of                    EF-Essential Future R-Required
                                 request to local,                  anonymize EHR information with a certain              effective healthcare 2.
                                 jurisdictional, national, and      specialization. For example: immunization,            Improve patient safety
                                 international registries.          disease, tumor, organ donor, or blood bank            3 Facilitate
                                                                    registries. EHRS applications must be able to         management of chronic
                                                                    lookup and update these registries according to the   conditions 4. Improve
                                                                    applicable rules and best-practices.                  efficiency 5. Facilitate
                                                                                                                          self-health
                                                                                                                          management 6. Ensure
                                                                                                                          privacy, confidentiality




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HL7       HL7                     HL7                              HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                     EHR                              EHR                                                     EHR                        EHR            Constrainable      Implementable
ID        Function                Function                         Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
          Name                    Statement                        Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                     CODING             CODING
                                                                                                                                                                     for Ambulatory - for Ambulatory -
                                                                                                                                                                     Outpatient       Outpatient
I.1.4.8   Resource and Location   The EHRS applications will       These registries will manage care unit identifiers,     1. Support delivery of                    EF-Essential Future R-Required
          Lookup                  be able to look up directories   point of care devices that contribute information to    effective healthcare 2.
                                  containing location              the EHR, and other relevant resources. For              Improve patient safety
                                  information, device, and         instance: if a new care unit is added in the location   3 Facilitate
                                  other resources relevant to      master file, the applications that use patient          management of chronic
                                  the EHR.                         location must update their list of available care       conditions 4. Improve
                                                                   units. Therefore, EHRS applications must be able        efficiency 5. Facilitate
                                                                   to receive notification when these directories have     self-health
                                                                   been updated.                                           management 6. Ensure
                                                                                                                           privacy, confidentiality




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HL7       HL7                     HL7                            HL7                                                  HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                     EHR                            EHR                                                  EHR                        EHR            Constrainable      Implementable
ID        Function                Function                       Functional                                           Rationale                  Secondary      Functional Profile Functional Profile
          Name                    Statement                      Description                                                                     Citation       PRIORITY           REQUIRED
                                                                                                                                                                CODING             CODING
                                                                                                                                                                for Ambulatory - for Ambulatory -
                                                                                                                                                                Outpatient       Outpatient
I.1.5     Interoperability




I.1.5.0   Vocabulary Functions    The EHRS must use              The EHRS will provide centralized vocabulary         1. Support delivery of                    E-Essential       R-Required
                                  consistent, codified medical   services which may be used by all the applications   effective healthcare 2.
                                  terminology to eliminate       in the EHRS. This way the EHRS ensure that           Improve patient safety
                                  ambiguity, confusion, and      coded terminologies are applied consistently         3 Facilitate
                                  ensure data correctness and    across applications. Additionally, this function     management of chronic
                                  interoperability.              ensures a                                            conditions 4. Improve
                                                                                                                      efficiency 5. Facilitate
                                                                                                                      self-health management




I.1.5.1   Standard Vocabulary     The EHR should comply          EHRS applications need to support a consistent set 1. Support delivery of                      E-Essential       R-Required
                                  with the Healthcare industry   of terminology. For example: LOINC, SNOMED, effective healthcare 2.
                                  standards for transactions     ICD9, CPT4.                                        Improve patient safety
                                  and terminology coding,                                                           3 Facilitate
                                  therefore the EHRS                                                                management of chronic
                                  applications must support                                                         conditions 4. Improve
                                  consistent a terminology                                                          efficiency 5. Facilitate
                                  model                                                                             self-health
                                                                                                                    management 6. Ensure
                                                                                                                    privacy, confidentiality

I.1.5.2   Consistent Vocabulary   The EHRS will support a       EHRS applications need to support a consistent set 1. Support delivery of                       E-Essential       R-Required
                                  consistent terminology model. of transactions and terminology. Exam HL7,         effective healthcare 2.
                                                                X12N, HIPAA.                                       Improve patient safety
                                                                                                                   3 Facilitate
                                                                                                                   management of chronic
                                                                                                                   conditions 4. Improve
                                                                                                                   efficiency 5. Facilitate
                                                                                                                   self-health
                                                                                                                   management 6. Ensure
                                                                                                                   privacy, confidentiality




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HL7       HL7                       HL7                              HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                       EHR                              EHR                                                    EHR                        EHR            Constrainable      Implementable
ID        Function                  Function                         Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
          Name                      Statement                        Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                      CODING             CODING
                                                                                                                                                                      for Ambulatory - for Ambulatory -
                                                                                                                                                                      Outpatient       Outpatient
I.1.5.3   Mapping for local terms   Support the ability to map       This function would be implemented by an EHRS          1. Support delivery of                    E-Essential       R-Required
                                    from local terminology to        application which uses a local terminology; that       effective healthcare 2.
                                    standard terminology.            terminology must be related to a standard              Improve patient safety
                                                                     terminology. For Example: If local terminology         3 Facilitate
                                                                     specifies a descriptive string for referring to        management of chronic
                                                                     "Ionized Calcium" that application must be able to     conditions 4. Improve
                                                                     replace the local code with a standard, for instance   efficiency 5. Facilitate
                                                                     LOINC, when creating EHR documentation for             self-health
                                                                     archival or exchange.                                  management 6. Ensure
                                                                                                                            privacy, confidentiality




I.1.5.4   Code Set Maintenance      Accommodate updates and          The EHRS needs to provide master files,                1. Support delivery of                    E-Essential       R-Required
                                    changes to terminology as        vocabulary services or other mechanisms such that      effective healthcare 2.
                                    the source terminology           code sets and vocabularies used for the EHR may        Improve patient safety
                                    undergoes its natural update     be maintained across application boundaries.           3 Facilitate
                                    process (new codes, retired      Additionally, if the code sets are changes, those      management of chronic
                                    codes, redirected codes).        changes should be reflected in all the relevant        conditions 4. Improve
                                    These changes in                 applications. For examples, if a new critical care     efficiency 5. Facilitate
                                    terminology need to be           unit is opened, the code used for that location        self-health
                                    propagated to all the clinical   should be present in the hospital master files and     management 6. Ensure
                                    reference sets (templates,       the new care unit should appear as an option in the    privacy, confidentiality
                                    custom formularies), etc.        Hospital Information System and all the clinical
                                    This functionality will also     application that operate in the new location,
                                    help when there is a desire to
                                    share standard templates
                                    (since, for instance, it would
                                    be hard to share templates
                                    without a shared
                                    terminology).




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HL7       HL7                   HL7                     HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                   EHR                     EHR                                                    EHR                        EHR            Constrainable      Implementable
ID        Function              Function                Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
          Name                  Statement               Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                         CODING             CODING
                                                                                                                                                         for Ambulatory - for Ambulatory -
                                                                                                                                                         Outpatient       Outpatient
I.1.5.5   Code Set Versioning   The EHRS will support   Version control allows for multiple sets/versions of   1. Support delivery of                    E-Essential       R-Required
                                version control for     the same terminology to exist and be distinctly        effective healthcare 2.
                                terminology.            recognized over time. Terminology versioning           Improve patient safety
                                                        supports retrospective analysis and research, as       3 Facilitate
                                                        well as interoperability with systems that comply      management of chronic
                                                        with different releases of the standard.               conditions 4. Improve
                                                                                                               efficiency 5. Facilitate
                                                                                                               self-health
                                                                                                               management 6. Ensure
                                                                                                               privacy, confidentiality




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HL7       HL7                        HL7                              HL7                                                   HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                        EHR                              EHR                                                   EHR                        EHR            Constrainable      Implementable
ID        Function                   Function                         Functional                                            Rationale                  Secondary      Functional Profile Functional Profile
          Name                       Statement                        Description                                                                      Citation       PRIORITY           REQUIRED
                                                                                                                                                                      CODING             CODING
                                                                                                                                                                      for Ambulatory - for Ambulatory -
                                                                                                                                                                      Outpatient       Outpatient
I.1.6     Manage Business
          Rules


I.1.6.0   Interoperability           EHRS application must be     These functions are critical to the successful            1. Support delivery of                    E-Essential        R-Required
                                     able to automate health      operation of the EHRS.                                    effective healthcare 2.
                                     delivery processes and                                                                 Improve patient safety
                                     seamlessly exchange clinical                                                           3 Facilitate
                                     (EHR) information.                                                                     management of chronic
                                                                                                                            conditions 4. Improve
                                                                                                                            efficiency 5. Facilitate
                                                                                                                            self-health
                                                                                                                            management 6. Ensure
                                                                                                                            privacy, confidentiality




I.1.6.1   Interaction-model -based   The EHRS applications must       This function requires that the EHRS application      1. Support delivery of                    EF-Essential Future R-Required
          exchange                   be able to exchange              support a variety of interaction models depending     effective healthcare 2.
                                     information with authorized      on type of interoperability required. This function   Improve patient safety
                                     entities using the appropriate   recognizes that an application must undergo           3 Facilitate
                                     interaction model:               several state changes to complete the information     management of chronic
                                                                      exchange with another application and that            conditions 4. Improve
                                                                      interoperability needs will determine the standard    efficiency 5. Facilitate
                                                                      to be used and the interaction mode. For instance,    self-health
                                                                      messaging is effective for many near-real time,       management 6. Ensure
                                                                      asynchronous data exchange scenarios but that         privacy, confidentiality
                                                                      same mode of interaction may not be applied if the
                                                                      end-user is requesting an immediate response from
                                                                      a remote application. Additionally, even in the
                                                                      case where store-and-forward, message-oriented
                                                                      interoperability is used, the applications may need
                                                                      to support the appropriate interaction mode. For
                                                                      example: Unsolicited Event Notifications,
                                                                      Query/Response, Query for display, Unsolicited
                                                                      summary, structured/discrete, and unstructured
                                                                      clinical documents. .




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HL7       HL7                HL7                               HL7                                                      HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                EHR                               EHR                                                      EHR                        EHR            Constrainable      Implementable
ID        Function           Function                          Functional                                               Rationale                  Secondary      Functional Profile Functional Profile
          Name               Statement                         Description                                                                         Citation       PRIORITY           REQUIRED
                                                                                                                                                                  CODING             CODING
                                                                                                                                                                  for Ambulatory - for Ambulatory -
                                                                                                                                                                  Outpatient       Outpatient
I.1.6.2   Chain of Trust     The EHRS must adhere to           This function requires that there is an overall          1. Support delivery of                    E-Essential       R-Required
                             documented procedures for         coordination of regarding what information is            effective healthcare 2.
                             executing chain of trust          exchange between EHRS entities and how that              Improve patient safety
                             agreements (in which the          exchange is expected to . The policies applied in at     3 Facilitate
                             parties agree to electronically   different locations must be consistent or                management of chronic
                             exchange data and protect         compatible with each other in order to ensure that       conditions 4. Improve
                             the integrity and                 the information is protected when it crosses entity      efficiency 5. Facilitate
                             confidentiality of the data       boundaries within the EHRS or with entities              self-health
                             exchanged).                       outside the EHRS.                                        management 6. Ensure
                                                                                                                        privacy, confidentiality




I.1.6.3   Standard-based     The EHRS applications must        This function identifies the dependency between          1. Support delivery of                    E-Essential       R-Required
          Interoperability   use standard-based                EHRS applications and EHRS infrastructure                effective healthcare 2.
                             information exchange              services or complementary application. The               Improve patient safety
                             methods to interact with          infrastructure services are those crucial to             3 Facilitate
                             local or remote application       application's ability to operate seamlessly with         management of chronic
                             registries, and directories.      complementary application. In turn these services        conditions 4. Improve
                                                               may be local or remote and require that the              efficiency 5. Facilitate
                                                               applications use a common messaging or                   self-health
                                                               programming interfaces to interoperate.                  management 6. Ensure
                                                               Interoperability with EHR Infrastructure services        privacy, confidentiality
                                                               such as directories, registries, etc. must be standard
                                                               based and EHRS applications must be capable to
                                                               use these interfaces. For example: an application
                                                               may use standard-based messaging (HL7 V3) to
                                                               look a patient's identity in a regional registry but
                                                               the same application might use CCOW in order to
                                                               synchronize the patient context with other EHRS
                                                               applications displayed on the same workstation.




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HL7         HL7                       HL7                             HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                       EHR                             EHR                                                    EHR                        EHR            Constrainable      Implementable
ID          Function                  Function                        Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
            Name                      Statement                       Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.6.3.1   Standard-based messaging An EHRS application must         When EHRS applications exchange information            1. Support delivery of                    E-Essential        R-Required
                                     be able to exchange standard-    (notifications, clinical summaries, documents, etc.)   effective healthcare 2.
                                     conformant message               they must rely on uniform standards and                Improve patient safety
                                     payloads and transport with      semantics. For instance, HL7 Messages for              3 Facilitate
                                     complementary applications       exchanging clinical observations, queries, and         management of chronic
                                     and infrastructure services      event notifications, CDA (Clinical Document            conditions 4. Improve
                                     (directory, vocabulary, etc.)    Architecture) for summary information and signed       efficiency 5. Facilitate
                                                                      clinical documents, X12N for billing.                  self-health
                                                                                                                             management 6. Ensure
                                                                                                                             privacy, confidentiality




I.1.6.3.2   Standard-based            An EHRS application must        Similar to standard-based messaging, standard-         1. Support delivery of                    E-Essential        R-Required
            application integration   be able to integrate with       based application integration requires that the        effective healthcare 2.
                                      complementary applications      EHRS application use standardized programming          Improve patient safety
                                      and infrastructure services     interfaces, where applicable. For example: CCOW        3 Facilitate
                                      (directory, vocabulary, etc.)   for visual integration, WfMC for workflow              management of chronic
                                      using standard-based            integration, etc.                                      conditions 4. Improve
                                      application programming                                                                efficiency 5. Facilitate
                                      interfaces (API). E.g. CCOW                                                            self-health
                                                                                                                             management 6. Ensure
                                                                                                                             privacy, confidentiality




I.1.6.3.3   Vocabulary lookup and     The EHRS must support           This function assumes that applications in the         1. Support delivery of                    EF-Essential Future R-Required
            mapping                   semantic interoperability       EHRS are using different standardized or local         effective healthcare 2.
                                      between EHRS application        vocabulary. In order to address the semantic           Improve patient safety
                                      by enabling lookup of           differences across these applications, vocabulary      3 Facilitate
                                      vocabulary mappings             lookup (to map local codes to standard codes) and      management of chronic
                                      between local and standard      mappings (to map one set of codes to another) the      conditions 4. Improve
                                      vocabularies as defined by      EHRS infrastructure will provide vocabulary            efficiency 5. Facilitate
                                      data exchange standards.        lookup and mapping (as a common service or             self-health
                                                                      distributed across applications).                      management 6. Ensure
                                                                                                                             privacy, confidentiality




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HL7         HL7                    HL7                              HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                    EHR                              EHR                                                    EHR                        EHR            Constrainable      Implementable
ID          Function               Function                         Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
            Name                   Statement                        Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                     CODING             CODING
                                                                                                                                                                     for Ambulatory - for Ambulatory -
                                                                                                                                                                     Outpatient       Outpatient
I.1.6.3.4   External Information   The EHRS must be able to         This function identifies the dependency between        1. Support delivery of                    EF-Essential Future R-Required
            Exchange               transmit messages to             EHRS applications and external applications and        effective healthcare 2.
                                   authorized third parties using   services. These external services/application may      Improve patient safety
                                   standard-based methods.          be offered by peer organizations or a intended to      3 Facilitate
                                                                    be shared across institutions. An example of           management of chronic
                                                                    External Information Exchange between peer             conditions 4. Improve
                                                                    institutions would be a patient referral. an example   efficiency 5. Facilitate
                                                                    of using a shared service would be eligibility         self-health
                                                                    lookup.                                                management 6. Ensure
                                                                                                                           privacy, confidentiality




I.1.6.3.5   Internal Information   Applications that comprise       This function requires that EHRS application use       1. Support delivery of                    E-Essential        R-Required
            Exchange               an EHRS will cooperate           the necessary standard-based methods to                effective healthcare 2.
                                   seamlessly and support data      communicate with complementary applications            Improve patient safety
                                   integration and consolidated     and services in such a way that the EHR can            3 Facilitate
                                   access across the system.        operate seamlessly. Initially, EHRS applications       management of chronic
                                                                    will exchange information with complementary           conditions 4. Improve
                                                                    applications. For instance, in order to determine      efficiency 5. Facilitate
                                                                    drug interactions the EHRS might need that a           self-health
                                                                    laboratory information system be integrated with       management 6. Ensure
                                                                    the a pharmacy information system.                     privacy, confidentiality

I.1.6.3.6   Recipient Addressing   When exchanging                  This function requires that an application sending     1. Support delivery of                    EF-Essential Future R-Required
                                   information with another         EHR-relevant information use the entity registries     effective healthcare 2.
                                   application, an EHRS             to ensure that the information is sent to the          Improve patient safety
                                   application must be able to      authorized receiver. Similarly, the receiver of the    3 Facilitate
                                   interact with entity             data must ensure that the sender is a valid,           management of chronic
                                   directories to determine the     authoritative source of information. This function     conditions 4. Improve
                                   recipients’ address profile.     requires that a conformant EHRS application be         efficiency 5. Facilitate
                                                                    able to access entity registries and use that          self-health
                                                                    information for addressing information                 management 6. Ensure
                                                                    transmission and validating inbound transmissions.     privacy, confidentiality




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HL7       HL7                   HL7                               HL7                                                   HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                   EHR                               EHR                                                   EHR                        EHR            Constrainable      Implementable
ID        Function              Function                          Functional                                            Rationale                  Secondary      Functional Profile Functional Profile
          Name                  Statement                         Description                                                                      Citation       PRIORITY           REQUIRED
                                                                                                                                                                  CODING             CODING
                                                                                                                                                                  for Ambulatory - for Ambulatory -
                                                                                                                                                                  Outpatient       Outpatient
I.1.6.4   Synchronization       The EHRS applications must        The EHRS is assumed to consist of a set of            1. Support delivery of                    E-Essential        R-Required
                                be able to interact with entity   application; each application manages a subset of     effective healthcare 2.
                                directories to link data          the EHR information. Therefore it is important        Improve patient safety
                                received from other               that through various interoperability mechanisms,     3 Facilitate
                                applications to existing entity   the EHRS maintains all the relevant information       management of chronic
                                records. Disparate systems        regarding the health record in synchrony. For         conditions 4. Improve
                                will be synchronized to keep      example, if an MRI is ordered by a physician, a set   efficiency 5. Facilitate
                                all the parts of the record       of diagnostic images and a radiology report will be   self-health
                                current.                          created. The patient demographics, the order for      management 6. Ensure
                                                                  MRI, the diagnostic images associated with the        privacy, confidentiality
                                                                  order, and the report associated with the study
                                                                  must all be in synch in order for the clinicians to
                                                                  view the complete EHR information.

I.1.6.5   EHR Data Extraction   The EHRS must be able to          Using certain EHRS applications, clinicians must      1. Support delivery of                    EF-Essential Future R-Required
                                extract data in accordance        be able to access and aggregate the distributed       effective healthcare 2.
                                with analysis and reporting       information that correspond to the Electronic         Improve patient safety
                                requirements. The data may        Health Record or Records which are needed for         3 Facilitate
                                reside on more that one           viewing, reporting, etc. EHRS application must be     management of chronic
                                application and it may be pre-    able to support data extraction operations whether    conditions 4. Improve
                                processed (e.g. de-identified)    the extract requires the application's own local      efficiency 5. Facilitate
                                before transmission. Data         information or an aggregation of information from     self-health
                                extractions could be to           more than one application. If the data required by    management 6. Ensure
                                retrospective EHR data or to      the end-user resides on other application, the        privacy, confidentiality
                                report public health              EHRS application responsible for data extraction
                                information.                      must query the other applications and display the
                                                                  information.

I.1.6.6   Clinical Documents    EHR s must be able to import      A significant part of the EHR consists of summary     1. Support delivery of                    EF-Essential Future R-Required
                                and export complex                reports and complex clinical documents. Therefore     effective healthcare 2.
                                standards-based clinical          the EHRS must support the effective exchange of       Improve patient safety
                                documents.                        such documents as atomic units of information.        3 Facilitate
                                                                  EHRS applications must be able to create and          management of chronic
                                                                  import clinical documents when needed.                conditions 4. Improve
                                                                                                                        efficiency 5. Facilitate
                                                                                                                        self-health
                                                                                                                        management 6. Ensure
                                                                                                                        privacy, confidentiality




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EHR       EHR                       EHR                             EHR                                                     EHR                        EHR            Constrainable      Implementable
ID        Function                  Function                        Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
          Name                      Statement                       Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                      CODING             CODING
                                                                                                                                                                      for Ambulatory - for Ambulatory -
                                                                                                                                                                      Outpatient       Outpatient
I.1.7     Workflow




I.1.7.0   Business Rules           Control system behavior via      Business Rules Administrative Functions include         1. Support delivery of                    E-Essential       R-Required
          Administrative Functions business rules. Example of       both the management of the business rules and the       effective healthcare 2.
                                   business rules that control      implementation functions that use business rules to     Improve patient safety
                                   system behavior are: decision    control system behavior. The implementation             3 Facilitate
                                   support, diagnostic support,     functions can be invoked from necessary points          management of chronic
                                   workflow control, access         within EHRS applications. Examples of                   conditions 4. Improve
                                   privileges, and system and       implementation functions include: decision              efficiency 5. Facilitate
                                   user defaults and preferences.   support, diagnostic support, workflow control,          self-health
                                                                    access privileges, and system and user defaults and     management 6. Ensure
                                                                    preferences.                                            privacy, confidentiality

I.1.7.1   Maintain Business Rules   Provide the ability for         This function supports creating, updating, and          1. Support delivery of                    E-Essential       R-Required
                                    authorized EHRS-Users to        deleting (or disabling) business rules by authorized    effective healthcare 2.
                                    create, update and delete       users. Business rules versioning is also supported      Improve patient safety
                                    business rules including        by this function. Business rule versioning is           3 Facilitate
                                    institutional preferences.      necessary to trace an action that was recommended       management of chronic
                                                                    based on a business rule, to the exact version of the   conditions 4. Improve
                                                                    business rule that was in place at the time the         efficiency 5. Facilitate
                                                                    recommendation was issued. Providers and                self-health
                                                                    institutions need the ability to customize decision     management 6. Ensure
                                                                    support components such as triggers, rules or           privacy, confidentiality
                                                                    algorithms, and the wording of alerts and advice,
                                                                    to meet local requirements and preferences. These
                                                                    local customizations must be supported and
                                                                    maintained as changes occur in the underlying
                                                                    systems and knowledge-bases.




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EHR       EHR                       EHR                            EHR                                                       EHR                        EHR            Constrainable      Implementable
ID        Function                  Function                       Functional                                                Rationale                  Secondary      Functional Profile Functional Profile
          Name                      Statement                      Description                                                                          Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.7.2   Implement/apply           Enable usage of business       The implementation function is invoked by                 1. Support delivery of                    E-Essential       R-Required
          business rules            rules by EHRS Supportive       applications throughout the EHRS to apply the             effective healthcare 2.
                                    functions.                     business rules that have been defined. For                Improve patient safety
                                                                   example: • When creating or updating a patient            3 Facilitate
                                                                   record with symptoms, the diagnostic support              management of chronic
                                                                   function may use this implementation function to          conditions 4. Improve
                                                                   determine if business rules exist to suggest              efficiency 5. Facilitate
                                                                   diagnosis based on the combination of symptoms            self-health
                                                                   (flu-like symptoms combined with widened                  management 6. Ensure
                                                                   mediastinum suggesting anthrax). • When creating          privacy, confidentiality
                                                                   a vaccination record the work flow process may
                                                                   use this implementation function to determine if
                                                                   business rules exist to send an update to an
                                                                   immunization registry. • When diagnosing a
                                                                   patient as pregnant, the decision support function
                                                                   may use this implementation function to determine
                                                                   if business rules exist to classify the patient as high
                                                                   risk due to factors such as age, health status, and
                                                                   prior pregnancy outcomes.

I.1.7.3   Override business rule    Support override of business   The override function allows authorized users to          1. Support delivery of                    E-Essential       R-Required
                                    rules by authorized EHRS-      dismiss a or bypass a recommendation for action           effective healthcare 2.
                                    Users.                         that was generated on the basis of business rules.        Improve patient safety
                                                                   Override may also be used to reset user                   3 Facilitate
                                                                   preferences or defaults.                                  management of chronic
                                                                                                                             conditions 4. Improve
                                                                                                                             efficiency 5. Facilitate
                                                                                                                             self-health
                                                                                                                             management 6. Ensure
                                                                                                                             privacy, confidentiality




I.1.7.4   Audit business rule usage Audit usage and override of    The EHRS will maintain a record of business rules         1. Support delivery of                    E-Essential       R-Required
                                    business rules (refer to       that are created, updated and disabled. In addition,      effective healthcare 2.
                                    section 3.2.5).                the EHRS will track the business rule that was            Improve patient safety
                                                                   used to issue a recommendation or guidance as             3 Facilitate
                                                                   well as the disposition of the business rule (if it       management of chronic
                                                                   was followed or bypassed).                                conditions 4. Improve
                                                                                                                             efficiency 5. Facilitate
                                                                                                                             self-health
                                                                                                                             management 6. Ensure
                                                                                                                             privacy, confidentiality




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EHR       EHR                     EHR                              EHR                                                    EHR                        EHR            Constrainable      Implementable
ID        Function                Function                         Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
          Name                    Statement                        Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                    CODING             CODING
                                                                                                                                                                    for Ambulatory - for Ambulatory -
                                                                                                                                                                    Outpatient       Outpatient
I.1.8.0   Workflow                Support Workflow                 Work flow functions include both the management        1. Support delivery of                    E-Essential        R-Required
                                  Management. Distribute           and setup of work queues, personnel, and system        effective healthcare 2.
                                  workflow-related EHRS            interfaces as well as the implementation functions     Improve patient safety
                                  information (according to        that use work flow related business rules to direct    3 Facilitate
                                  established business rules)      tasks to queues. The implementation functions can      management of chronic
                                  within the EHRS and to/from      be invoked from necessary points within EHRS           conditions 4. Improve
                                  external parties.                applications. Note that workflow definitions and       efficiency 5. Facilitate
                                                                   management may be implemented by a designated          self-health
                                                                   application or distributed across EHRS                 management 6. Ensure
                                                                   applications.                                          privacy, confidentiality

I.1.8.1   Task Distribution       Support workflow task-           This function supports creating, updating and          1. Support delivery of                    EF-Essential Future R-Required
                                  management and task-             disabling work queues, assignees, system               effective healthcare 2.
                                  distribution systems             destinations, work flow algorithms, and links          Improve patient safety
                                  (including serial tasks and      between work flow components and business rules        3 Facilitate
                                  parallel tasks).                 (maintained by the business rules functions).          management of chronic
                                                                   Examples of links include: queues to                   conditions 4. Improve
                                                                   recipients/roles, business rules to work flow          efficiency 5. Facilitate
                                                                   algorithms and distribution paths, and escalation      self-health
                                                                   and redirection rules to roles/users. Work flow        management 6. Ensure
                                                                   algorithms include the routing of tasks down single    privacy, confidentiality
                                                                   dependent paths or multiple independent paths. For
                                                                   example: • Serial tasks - An initial X-ray may be
                                                                   required prior to ordering an MRI. • Parallel tasks-
                                                                   When a patient is in the process of being admitted
                                                                   for scheduled surgery, the registration department
                                                                   may be asked for last-minute insurance coverage
                                                                   verification, while the lab may simultaneously be
                                                                   asked whether pre-admission lab work has been
                                                                   completed.

I.1.8.2   System-triggered Task   Support workflow                 This function specifies that task routing can be       1. Support delivery of                    EF-Essential Future R-Required
          Routing                 notifications and task routing   based on the type of diagnosis or other system         effective healthcare 2.
                                  based on system triggers such    triggers. Diagnosis based routing uses business        Improve patient safety
                                  as diagnosis assignments.        rules (maintained by the business rules functions)     3 Facilitate
                                                                   to determine the routing path that should be           management of chronic
                                                                   followed. For example: • Updates to clinical           conditions 4. Improve
                                                                   registries (cancer is detected), blood banks (HIV is   efficiency 5. Facilitate
                                                                   detected), or donor banks (kidney is available). •     self-health
                                                                   Notifications to social service agencies               management 6. Ensure
                                                                   (Alzheimer's disease is detected or child abuse is     privacy, confidentiality
                                                                   suspected). • Updates to immunization registry
                                                                   (patient receives vaccination).




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EHR       EHR             EHR                      EHR                                                    EHR                        EHR            Constrainable      Implementable
ID        Function        Function                 Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
          Name            Statement                Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                    CODING             CODING
                                                                                                                                                    for Ambulatory - for Ambulatory -
                                                                                                                                                    Outpatient       Outpatient
I.1.8.3   Workflow task   Support workflow task-   This set of work flow tasks are invoked to direct      1. Support delivery of                    EF-Essential Future R-Required
          assignment      assignments, task-       tasks to the correct work queue to support initial     effective healthcare 2.
                          escalations, and task-   assignment, escalation of work not completed in a      Improve patient safety
                          redirections.            timely manner, and redirection of tasks. Work          3 Facilitate
                                                   Flow utilizes business rules (maintained by the        management of chronic
                                                   business rules functions) to determine the routing     conditions 4. Improve
                                                   of a task. Examples of task routing include: •         efficiency 5. Facilitate
                                                   Assigning a documents-checking task before             self-health
                                                   discharging a patient (according to length-of-stay     management 6. Ensure
                                                   business rules). For example, a patient staying in a   privacy, confidentiality
                                                   hospital for more than 24 hours cannot be
                                                   discharged unless that patient's medical history and
                                                   physical examination have been documented. •
                                                   Assigning an insurance-verification task when a
                                                   patient is admitted. • Escalating a task to a
                                                   supervisor when that task was not completed
                                                   within the business rule -specified time frame. •
                                                   Redirecting a task when an employee becomes
                                                   unavailable or over-tasked (as defined by business
                                                   rules).




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                                    E-Essential           R-Required




                                    EF-Essential Future   M-Maybe




                                    O-Optional            X-Not Supported




                                    X-Not Applicable




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DoD EHR - For Public Distribution   DoD EHR - HL7 EHR Mapping    HL7 EHR-S Profile Coding




Version 7.0                               page 136 of 144       Version Date: 23 February 2004
DoD EHR - For Public Distribution   DoD EHR - HL7 EHR Mapping    HL7 EHR-S Profile Coding




Version 7.0                               page 137 of 144       Version Date: 23 February 2004
DoD EHR - For Public Distribution   DoD EHR - HL7 EHR Mapping    HL7 EHR-S Profile Coding




Version 7.0                               page 138 of 144       Version Date: 23 February 2004
DoD EHR - For Public Distribution   DoD EHR - HL7 EHR Mapping    HL7 EHR-S Profile Coding




Version 7.0                               page 139 of 144       Version Date: 23 February 2004
DoD EHR - For Public Distribution   DoD EHR - HL7 EHR Mapping    HL7 EHR-S Profile Coding




Version 7.0                               page 140 of 144       Version Date: 23 February 2004
DoD EHR - For Public Distribution   DoD EHR - HL7 EHR Mapping    HL7 EHR-S Profile Coding




Version 7.0                               page 141 of 144       Version Date: 23 February 2004
DoD EHR - For Public Distribution   DoD EHR - HL7 EHR Mapping    HL7 EHR-S Profile Coding




Version 7.0                               page 142 of 144       Version Date: 23 February 2004
DoD EHR - For Public Distribution   DoD EHR - HL7 EHR Mapping    HL7 EHR-S Profile Coding




Version 7.0                               page 143 of 144       Version Date: 23 February 2004
DoD EHR - For Public Distribution   DoD EHR - HL7 EHR Mapping    HL7 EHR-S Profile Coding




Version 7.0                               page 144 of 144       Version Date: 23 February 2004

				
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