80_FR_77106 80 FR 76868 - 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications; Corrections and Clarifications

80 FR 76868 - 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications; Corrections and Clarifications

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary

Federal Register Volume 80, Issue 238 (December 11, 2015)

Page Range76868-76872
FR Document2015-31255

This document corrects errors and clarifies provisions of the final rule entitled ``2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications.''

Federal Register, Volume 80 Issue 238 (Friday, December 11, 2015)
[Federal Register Volume 80, Number 238 (Friday, December 11, 2015)]
[Rules and Regulations]
[Pages 76868-76872]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-31255]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary

45 CFR Part 170

RIN 0991-AB93


2015 Edition Health Information Technology (Health IT) 
Certification Criteria, 2015 Edition Base Electronic Health Record 
(EHR) Definition, and ONC Health IT Certification Program 
Modifications; Corrections and Clarifications

AGENCY: Office of the National Coordinator for Health Information 
Technology (ONC), Department of Health and Human Services (HHS).

ACTION: Final rule; corrections and clarifications.

-----------------------------------------------------------------------

SUMMARY: This document corrects errors and clarifies provisions of the 
final rule entitled ``2015 Edition Health Information Technology 
(Health IT) Certification Criteria, 2015 Edition Base Electronic Health 
Record (EHR) Definition, and ONC Health IT Certification Program 
Modifications.''

DATES: This correction is effective January 14, 2016. The final rule 
appeared in the Federal Register on October 16, 2015 (80 FR 62602), and 
is effective on January 14, 2016, except for Sec.  170.523(m) and (n), 
which are effective on April 1, 2016.

FOR FURTHER INFORMATION CONTACT: Michael Lipinski, Office of Policy, 
National Coordinator for Health Information Technology, 202-690-7151.

SUPPLEMENTARY INFORMATION: 

I. Background

    Following the publication of Federal Register document 2015-25597 
of October 16, 2015 (80 FR 62602), final rule entitled ``2015 Edition 
Health Information Technology (Health IT) Certification Criteria, 2015 
Edition Base Electronic Health Record (EHR) Definition, and ONC Health 
IT Certification Program Modifications'' (hereinafter referred to as 
the 2015 Edition final rule), we identified a number of errors in the 
final rule. We summarize and correct these errors in the ``Summary of 
Errors'' and ``Corrections of Errors'' sections below.
    We also clarify requirements of the Common Clinical Data Set 
(CCDS), the privacy and security certification framework, and the 
mandatory disclosures for health IT developers in the 
``Clarifications'' section below.

II. Summary of Errors

A. Preamble Errors

1. ``Audit Report(s)'' Certification Criterion
    We incorrectly identified the adopted 2015 Edition ``audit 
report(s)'' certification criterion throughout the preamble as 
``unchanged'' and eligible for gap certification. More specifically, we 
identified it incorrectly:
    a. On page 62609, under Table 2 (``2015 Edition Health IT 
Certification Criteria''), as an unchanged criterion compared to the 
2014 Edition and gap certification eligible.
    b. On page 62656, second column, in the ``Response'' under ``Audit 
Report(s),'' as adopted as proposed (i.e., ``unchanged'').
    c. On page 62681, under Table 6 (``Gap Certification Eligibility 
for 2015 Edition Health IT Certification Criteria''), as eligible for 
gap certification.
    We adopted the standard at Sec.  170.210(e) as revised to include 
the auditing of changes to user privileges in paragraph (e)(1)(i). The 
adopted 2015 Edition ``audit report(s)'' certification criterion 
references this standard. Therefore, it is a ``revised'' certification 
criterion as compared to the 2014 Edition ``audit report(s)'' 
certification criterion and ineligible for gap certification.
2. ``Integrity'' Certification Criterion
    On page 62657, third column, third paragraph, the last sentence 
incorrectly references SHA-1. The commenters' statements were specific 
to SHA-2.
3. ``Accounting of Disclosures'' Certification Criterion
    On page 62658, first column, mid-page, within the 2015 Edition 
``accounting of disclosures'' certification criterion table, we 
inadvertently referenced the criterion as codified in 45 CFR 
170.315(d)(10), when in fact it was codified in 45 CFR 170.315(d)(11). 
We note that the 2015 Edition ``auditing actions on health 
information'' certification criterion was codified in 45 CFR 
170.315(d)(10).
4. ``Transmission to Public Health Agencies--Antimicrobial Use and 
Resistance Reporting'' Certification Criterion
    On page 62668, third column, lines 2 and 3, there was a 
parenthetical error stating that we adopted the ``transmission to 
public health agencies--antimicrobial use and resistance reporting'' 
certification criterion as proposed (with both Volumes 1 and 2 of the 
HAI IG). The parenthetical is corrected to not reference volumes of the 
HL 7 Implementation Guide for CDA[supreg] Release 2--Level 3: 
Healthcare Associated Infection Reports, Release 1

[[Page 76869]]

(U.S. Realm), August 9, 2013 (HAI IG). This adopted version of the HAI 
IG does not contain multiple volumes. Further, the adopted version of 
the implementation guide was incorporated by reference in Sec.  
170.299(f)(26).
5. Common Clinical Data Set--Assessment and Plan of Treatment, Goals, 
and Health Concerns
    On page 62696, second column, lines 8-14, we did not clearly 
indicate that only the narrative parts of the ``Goals Section'' and 
``Health Concerns Section'' needed to be met in order to meet the CCDS 
definition. We refer readers to section III.A (``Common Clinical Data 
Set'') below for further clarification of these CCDS requirements.

B. Regulation Text Errors

1. 2015 Edition Base EHR Definition
    On page 62742, first column, line 16 (Sec.  170.102), we 
inadvertently made an error in the 2015 Edition Base EHR definition by 
citing to Sec.  170.315(a)(15) instead of Sec.  170.315(a)(14). As 
discussed on pages 62625, 62630, 62691 and identified on page 62692 
(Table 7), we included the ``implantable device list'' certification 
criterion (Sec.  170.315(a)(14)) in the 2015 Edition Base EHR 
definition as we proposed (80 FR 16806, 16825, 16870-16871). We did not 
propose to include nor intend to include the ``social, psychological, 
and behavioral data'' certification criterion (Sec.  170.315(a)(15)) in 
the 2015 Edition Base EHR definition.
2. Sexual Orientation Code
    On page 62744, third column, line 24 (Sec.  170.207(o)(1)(ii)), the 
code (20730005) attributed to ``straight or heterosexual'' was 
inaccurate. The correct code is 20430005 (emphasis added).
3. ``Implantable Device List'' Certification Criterion
    On page 62748, third column, line 1 (Sec.  170.315(a)(14)), we 
inadvertently omitted the word ``and'' at the end of the line. On the 
same page and column, line 42, we inadvertently added the word ``and'' 
when the ``and'' should have been at the end of line 47. On the same 
page and column, line 59, we inadvertently omitted the word ``and'' at 
the end of the line.
4. ``Data Export'' Certification Criterion
    On page 62750, third column, line 63, we inaccurately cross-
referenced paragraphs (ii) through (v) of the ``data export'' 
certification criterion (Sec.  170.315(b)(6)), when the cross-reference 
should have only been to paragraphs (iii) and (iv). Paragraph (v) 
should not have been referenced because there are only four paragraphs, 
ending with paragraph (iv). Paragraph (ii) should not have been cross-
referenced because paragraph (ii) no longer includes a configuration 
capability that could be enabled. The configuration capability included 
in paragraph (ii) was intended to support user selection among the 
multiple document templates we proposed for inclusion in paragraph (ii) 
of this certification criterion. In the final rule, however, we only 
included the Continuity of Care Document (CCD) document template in 
paragraph (ii). Therefore, a configuration capability for selecting 
among document templates is no longer applicable and both the cross-
reference to paragraph (ii) and the inclusion of configuration language 
in paragraph (ii) on page 62751, first column, lines 10-11, are 
incorrect. In terms of the configuration language in paragraph (ii), 
more specifically the inclusion of ``configuration'' in the paragraph 
title is an error as is the inclusion of the capability to ``configure 
the technology'' in the first sentence.
5. ``Clinical Quality Measures--Filter'' Certification Criterion
a. Patient Insurance Standard
    On page 62751, third column, line 22, we inadvertently included 
``at a minimum'' language for the required patient insurance standard. 
The standard (Source of Payment Typology Code Set Version 5.0 (October 
2011)) was adopted at Sec.  170.207(s)(1), but we did not adopt this 
standard as a ``minimum standards'' code set (see 80 FR 62612).
b. Patient Sex Standard
    On page 62751, third column, lines 25-26, we inadvertently included 
``at a minimum'' language for the required patient sex standard. The 
standard for representing sex is the use of specific HL7 Version 3 
codes and was adopted at Sec.  170.207(n)(1). We did not adopt this 
standard as a ``minimum standards'' code set (see 80 FR 62612).
6. ``View, Download, and Transmit to 3rd Party'' (VDT) Certification 
Criterion
    On page 62753, first column, lines 37 and 55 (Sec.  
170.315(e)(1)(ii)), we inadvertently omitted references for a patient's 
authorized representative to have access to the specified capabilities 
related to the activity history log under the VDT certification 
criterion. As discussed on page 62658 and consistent with references 
throughout the VDT criterion, a patient's authorized representative 
access to these capabilities is the same as the patient for the 
purposes of testing and certification.
7. ``Consolidated CDA Creation Performance'' Certification Criterion
    On page 62754, second column, lines 42-46 (Sec.  
170.315(g)(6)(ii)), we inadvertently included a sentence stating that 
the scope of this certification criterion will not exceed the 
evaluation of the CCD, Referral Note, and Discharge Summary document 
templates. This statement is inconsistent with the preamble guidance of 
the final rule on page 62674, which states that we have required that 
Consolidated CDA (C-CDA) creation performance be demonstrated for the 
C-CDA Release 2.1 document templates required by the 2015 Edition 
certification criteria presented for certification. Certification to 
some criteria (e.g., the ``transitions of care'' criterion) requires 
three C-CDA document templates whereas other criteria (e.g., the ``care 
plan'' criterion) only requires one C-CDA document template. To further 
illustrate, if a Health IT Module only included the ``view, download, 
and transmit to 3rd party'' certification criterion (Sec.  
170.315(e)(1)) within its certificate's scope, then only the Continuity 
of Care Document (CCD) document template would be applicable within the 
``C-CDA creation performance'' criterion. Conversely, if a Health IT 
Module designed for the inpatient setting included the ``transitions of 
care'' certification criterion (Sec.  170.315(b)(1)) within its 
certificate's scope, then all three document templates referenced by 
that criterion (CCD, Referral Note, and Discharge Summary) would need 
to be evaluated as part of the ``C-CDA creation performance'' 
criterion, with the Discharge Summary only applicable to the inpatient 
setting.
8. ``Direct Project'' Certification Criterion
    On page 62755, first column, lines 53 through 55 (Sec.  
170.315(h)(1)(ii)), we inadvertently referenced the ``Applicability 
Statement for Secure Health Transport'' in the title for paragraph (ii) 
when it should have only been ``Delivery Notification in Direct.''
9. ``Direct Project, Edge Protocol, and XDR/XDM'' Certification 
Criterion
    On page 62755, second column, lines 4 through 6 (Sec.  
170.315(h)(2)(ii)), we again inadvertently referenced the 
``Applicability Statement for Secure Health Transport'' in the title 
for paragraph (ii) when it should have only been ``Delivery 
Notification in Direct.''

[[Page 76870]]

10. Principles of Proper Conduct for ONC-ACBs--Certified Health IT 
Mandatory Disclosures
a. 2015 Edition Certified Health IT
    On page 62756, third column, lines 35-36 (Sec.  
170.523(k)(1)(ii)(A)), we inadvertently cross-referenced the wrong data 
from Sec.  170.523(f)(1). We did not intend to cross-reference Sec.  
170.523(f)(1)(xvii) (certification to standards used to meet a 
certification criterion). The required data elements for disclosure 
were intended to be consistent across the editions. This data is not a 
required data element for the mandatory disclosures for health IT 
certified to the 2014 Edition. We did, however, intend to require the 
disclosure of Sec.  170.523(f)(1)(xv) (certification to clinical 
quality measures), which was inadvertently omitted but consistent with 
the new and previous 2014 Edition disclosure requirements. We also 
refer readers to section III.C (``Mandatory Disclosures for 2015 
Edition Certified Health IT'') below for a clarification related to the 
disclosure on information specified in Sec.  170.523(f)(1)(viii).
b. 2014 Edition Certified Health IT
    On page 62756, third column, lines 42-43 (Sec.  
170.523(k)(1)(ii)(B)), we inadvertently omitted cross-references to 
paragraphs (f)(2)(iii) (product version) and (vi) (any additional 
relied upon software used to demonstrate compliance with a 
certification criterion or criteria) of Sec.  170.523. The parallel 
requirements were included in the required disclosures for health IT 
certified to the 2015 Edition and were previously required to be 
disclosed as part of certification to the 2014 Edition.
10. In-the-Field Surveillance and Maintenance of Certification for 
Health IT
a. Exclusion and Exhaustion
    On page 62758, third column, lines 4 and 10 (Sec.  170.556(c)(5)), 
we twice inadvertently cross-referenced paragraph (c)(3) of Sec.  
170.556 instead of paragraph (c)(4) of Sec.  170.556. Paragraph (c)(4) 
includes the requirements for locations as they would apply to the 
``exclusion and exhaustion'' requirements of paragraph (c)(5).
b. Termination
    On page 62759, second column, lines 23-24 (Sec.  170.556(d)(6)), we 
inadvertently included language suggesting that termination was limited 
to suspensions in the context of randomized surveillance. Consistent 
with the preamble discussion on pages 62716-62718, termination can 
follow any suspension if the health IT developer has not completed the 
actions necessary to reinstate the suspended certification.

III. Clarifications

A. Common Clinical Data Set

    In the final rule (Sec.  170.102), we define the CCDS to mean data 
expressed, where indicated, according to specified standards. For four 
data specified in the CCDS (Unique Device Identifier(s) for a Patient's 
Implantable Device(s); Assessment and Plan of Treatment; Goals; and 
Health Concerns), we reference specific Consolidated Clinical Document 
Architecture (C-CDA) sections. Based on subsequent examination of this 
regulatory text and early interactions with stakeholders, we have 
determined that additional explanation of these references is necessary 
in order to ensure health IT developers accurately and consistently 
interpret and implement health IT functionality to our expressed 
regulatory requirements. In this regard, we seek to clarify two points.
    First, we clarify that the references to these four specific C-CDA 
section templates is not meant to be strictly interpreted to mean that 
a health IT developer must use the C-CDA's syntax for each referenced 
section. Such a strict interpretation would directly contradict the 
flexibility we have intentionally offered to health IT developers who 
seek to certify to the ``application access--data category request'' 
certification criterion adopted at 45 CFR 170.315(g)(8), which 
references the CCDS but does not bind health IT presented for 
certification to solely use the C-CDA to meet the criterion. To avoid 
stakeholders inadvertently following this overly strict interpretation, 
we clarify that the references to these C-CDA section templates was 
meant (like all of the other data listed in the CCDS) to emphasize that 
these data need to be consistently and independently represented as 
discrete data that are clearly distinguishable.
    Second, we clarify for the Assessment and Plan of Treatment, Goals, 
and Health Concerns data that only the narrative part of the referenced 
C-CDA section templates is necessary and required in order to satisfy 
the CCDS. Further and in support of this clarification, testing and 
certification will focus on the presence of data represented consistent 
with just the narrative part of the referenced section templates. 
Similar to our points above, given that these section templates in the 
C-CDA have two parts (a narrative part and coded requirements part for 
C-CDA), we believe that it is necessary to make this interpretation 
explicit so as to prevent health IT developers from over-interpreting 
this definition's data requirements to include more data than we had 
intended.

B. Privacy and Security Certification Framework--Approach 2

    Under Sec.  170.550(h)(4)(ii), a Health IT Module can meet 
applicable 2015 Edition privacy and security certification criterion by 
demonstrating, through system documentation that is sufficiently 
detailed to enable integration, that the Health IT Module has 
implemented service interfaces for each applicable privacy and security 
certification criterion that enable the Health IT Module to access 
external services necessary to meet the privacy and security 
certification criterion (also known as ``Approach 2''). We clarify 
three points about Approach 2. First, we clarify that the term 
``access'' includes, as applicable, bi-directional interfaces with 
external services. For example, system documentation could detail how 
integration establishes a bi-directional interface that meets the 
requirements of the 2015 Edition ``audit report(s)'' certification 
criterion. Second, external services simply mean services outside the 
scope of the Health IT Module being presented for certification. 
External services could be, but are not limited to, those provided by 
another certified Health IT Module, another software program such as 
Microsoft Active Directory, or a hospital enterprise-wide 
infrastructure. Third, a Health IT Module is not required to be paired 
with the other services for the purposes of certification (e.g., 
certified with another certified Health IT Module that performs the 
privacy and security capability or specifying the external services as 
``relied upon software'').

C. Mandatory Disclosures for 2015 Edition Certified Health IT

    We clarify that for compliance with Sec.  170.523(k)(1)(ii)(A), the 
only information that must be disclosed to meet the data requirement 
specified in Sec.  170.523(f)(1)(viii) is the certification criterion 
or criteria to which the Health IT Module has been certified. This is 
consistent with the disclosure requirements for certification to the 
2014 Edition.

IV. Waiver of Proposed Rulemaking

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register to provide a period for public comment before the 
provisions of a rule take effect in accordance with section

[[Page 76871]]

553(b) of the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). 
However, we can waive this notice and comment procedure if the 
Secretary finds, for good cause, that the notice and comment process is 
impracticable, unnecessary, or contrary to the public interest, and 
incorporates a statement of the finding and the reasons therefore in 
the notice.
    In our view, this correcting and clarifying document does not 
constitute a rulemaking that would be subject to the APA notice and 
comment requirements. This document corrects errors and clarifies 
provisions of the 2015 Edition final rule published on October 16, 
2015. It does not make substantive changes to the policies that were 
adopted. As a result, this correcting document is intended to ensure 
that the final rule accurately reflects the policies adopted in that 
final rule.
    In addition, even if this were a rulemaking to which the notice and 
comment requirements applied, we find that there is good cause to waive 
such requirements. Undertaking further notice and comment procedures to 
incorporate the corrections in this document into the final rule would 
be contrary to the public interest. Furthermore, such procedures would 
be unnecessary, as we are not altering the policies that were already 
subject to comment and finalized in our final rule. Therefore, we 
believe we have good cause to waive the notice and comment 
requirements.

V. Corrections of Errors

A. Preamble Corrections

    1. On page 62609, correct Table 2 as follows:
    a. Remove ``Audit Report(s)'' from the ``Unchanged Criteria as 
Compared to the 2014 Edition (Gap Certification Eligible)'' category 
and insert it with an in asterisk (i.e., Audit Report(s)*) in the 
``Revised Criteria as Compared to the 2014 Edition'' category after 
``Auditable Events and Tamper-Resistance.''
    b. Revise the ``Unchanged Criteria as Compared to the 2014 Edition 
(Gap Certification Eligible) (16)'' title to ``Unchanged Criteria as 
Compared to the 2014 Edition (Gap Certification Eligible) (15)''.
    c. Revise the ``Revised Criteria as Compared to the 2014 Edition 
(25)'' title to ``Revised Criteria as Compared to the 2014 Edition 
(26)''.
    2. On page 62656, second column, in the ``Response'' under ``Audit 
Report(s),'' correct the first sentence to read ``We have adopted this 
certification criterion as revised to support the audit reporting of 
changes in user privileges consistent with the adopted 2015 Edition 
``auditable events and tamper resistance'' certification criterion.''
    3. On page 62657, third column, third paragraph, correct the last 
sentence to read ``A few commenters requested that we wait until 2017 
or 2018 to increase the standard to SHA-2.''
    4. On page 62658, first column, mid-page, within the 2015 Edition 
``accounting of disclosures'' certification criterion table, the 
citation is corrected to read ``45 CFR 170.315(d)(11).''
    5. On page 62668, third column, lines 2 and 3, correct the 
parenthetical to read ``(with the HAI IG).''
    6. On page 62681, Table 6, remove ``(d)(3) Audit report(s)'' from 
the ``2015 Edition'' column and ``(d)(3) Audit report(s)'' from the 
``2014 Edition'' column.
    7. On page 62696, second column, lines 8-14, correct the sentence 
to read ``Thus, other C-CDA document templates such as CCD, Referral 
Note, and Discharge Summary would need to be able to exchange the 
narrative information from the ``Goals Section'' and ``Health Concerns 
Section'' in order to meet the Common Clinical Data Set definition.''

B. Regulation Text Corrections

0
1. On page 62742, first column, in Sec.  170.102, in the definition of 
``2015 Edition Base EHR'', paragraph (3) is corrected to read as 
follows:


Sec.  170.102  Definitions.

* * * * *
    2015 Edition Base EHR * * *
    (3) Has been certified to the certification criteria adopted by the 
Secretary in Sec.  170.315(a)(1), (2), or (3); (a)(5) through (9); 
(a)(11); (a)(14); (b)(1) and (6); (c)(1); (g)(7) through (9); and 
(h)(1) or (2);
* * * * *

0
2. On page 62744, third column, in Sec.  170.207, paragraph (o)(1)(ii) 
is corrected to read as follows:


Sec.  170.207  Vocabulary standards for representing electronic health 
information.

* * * * *
    (o) * * *
    (1) * * *
    (ii) Straight or heterosexual. 20430005.
* * * * *

0
3. On pages 62748 through 62755, in Sec.  170.315, paragraphs 
(a)(14)(ii)(A), (a)(14)(iv)(A) and (B), (a)(14)(v)(C), (b)(6)(i)(A), 
(b)(6)(ii) introductory text, (c)(4)(iii)(E) and (G), (e)(1)(ii)(A) 
introductory text, (e)(1)(ii)(B), (g)(6)(ii), (h)(1)(ii), and 
(h)(2)(ii) are corrected to read as follows:


Sec.  170.315  2015 Edition health IT certification criteria.

* * * * *
    (a) * * *
    (14) * * *
    (ii) * * *
    (A) Device Identifier; and
* * * * *
    (iv) * * *
    (A) The active Unique Device Identifiers recorded for the patient;
    (B) For each active Unique Device Identifier recorded for a 
patient, the description of the implantable device specified by 
paragraph (a)(14)(iii)(A) of this section; and
* * * * *
    (v) * * *
    (C) The identifiers associated with the Unique Device Identifier, 
as specified by paragraph (a)(14)(ii) of this section; and
* * * * *
    (b) * * *
    (6) * * *
    (i) * * *
    (A) Enable a user to set the configuration options specified in 
paragraphs (b)(6)(iii) and (iv) of this section when creating an export 
summary as well as a set of export summaries for patients whose 
information is stored in the technology. A user must be able to execute 
these capabilities at any time the user chooses and without subsequent 
developer assistance to operate.
* * * * *
    (ii) Creation. Enable a user to create export summaries formatted 
in accordance with the standard specified in Sec.  170.205(a)(4) using 
the Continuity of Care Document document template that includes, at a 
minimum:
* * * * *
    (c) * * *
    (4) * * *
    (iii) * * *
    (E) Patient insurance in accordance with the standard specified in 
Sec.  170.207(s)(1).
    * * *
    (G) Patient sex in accordance with the version of the standard 
specified in Sec.  170.207(n)(1).
* * * * *
    (e) * * *
    (1) * * *
    (ii) * * *
    (A) When any of the capabilities included in paragraphs 
(e)(1)(i)(A) through (C) of this section are used, the following 
information must be recorded and made accessible to the patient (or 
his/her authorized representative):
* * * * *
    (B) Technology presented for certification may demonstrate

[[Page 76872]]

compliance with paragraph (e)(1)(ii)(A) of this section if it is also 
certified to the certification criterion specified in Sec.  
170.315(d)(2) and the information required to be recorded in paragraph 
(e)(1)(ii)(A) of this section is accessible by the patient (or his/her 
authorized representative).
* * * * *
    (g) * * *
    (6) * * *
    (ii) Document-template conformance. Create a data file formatted in 
accordance with the standard adopted in Sec.  170.205(a)(4) that 
demonstrates a valid implementation of each document template 
applicable to the certification criterion or criteria within the scope 
of the certificate sought.
* * * * *
    (h) * * *
    (1) * * *
    (ii) Delivery Notification in Direct. Able to send and receive 
health information in accordance with the standard specified in Sec.  
170.202(e)(1).
* * * * *
    (2) * * *
    (ii) Delivery Notification in Direct. Able to send and receive 
health information in accordance with the standard specified in Sec.  
170.202(e)(1).


Sec.  170.523  [Corrected]

0
4. In Sec.  170.523--
0
a. On page 62756, third column, lines 35-36, paragraph (k)(1)(ii)(A), 
the reference ``paragraphs (f)(1)(i), (vi), (vii), (viii), (xvi), and 
(xvii) of this section'' is corrected to read ``paragraphs (f)(1)(i), 
(vi), (vii), (viii), (xv), and (xvi) of this section''.
0
b. On page 62756, third column, lines 42-43, paragraph (k)(1)(ii)(B), 
the reference ``paragraphs (f)(2)(i), (ii), (iv)-(v), and (vii) of this 
section'' is corrected to read ``paragraphs (f)(2)(i) through (vii) of 
this section''.

0
5. In Sec.  170.556--
0
a. On page 62758, third column, lines 4 and 10, paragraph (c)(5), 
correct the reference ``paragraph (c)(3)'' each time it appears to read 
``paragraph (c)(4)''.
0
b. On page 62759, second column, correct paragraph (d)(6) to read as 
follows:


Sec.  170.556  In-the-field surveillance and maintenance of 
certification for Health IT.

* * * * *
    (d) * * *
    (6) If a certified Complete EHR or certified Health IT Module's 
certification has been suspended, an ONC-ACB is permitted to initiate 
certification termination procedures for the Complete EHR or Health IT 
Module (consistent with its accreditation to ISO/IEC 17065 and 
procedures for terminating a certification) when the developer has not 
completed the actions necessary to reinstate the suspended 
certification.
* * * * *

    Dated: December 7, 2015.
Madhura Valverde,
Executive Secretary to the Department, Department of Health and Human 
Services.
[FR Doc. 2015-31255 Filed 12-10-15; 8:45 am]
 BILLING CODE 4150-45-P



                                            76868                Federal Register / Vol. 80, No. 238 / Friday, December 11, 2015 / Rules and Regulations

                                                                                                   SOUTH CAROLINA—2008 8-HOUR OZONE NAAQS
                                                                                                                     [Primary and secondary]

                                                                                                              Designation                                                    Classification
                                                   Designated area
                                                                                              Date 1                              Type                           Date 1                       Type

                                            Charlotte-Rock Hill, NC–             This action is effective 12/       Attainment.
                                              SC: 2.                               11/2015.
                                                York County (part)
                                                  Portion along MPO
                                                  lines.

                                                         *                        *                       *                        *                       *                       *                 *
                                                1 Thisdate is July 20, 2012, unless otherwise noted.
                                                2 Excludes Indian country located in each area, unless otherwise noted.
                                                3 IncludesIndian country of the tribe listed in this table located in the identified area. Information pertaining to areas of Indian country in this
                                            table is intended for CAA planning purposes only and is not an EPA determination of Indian country status or any Indian country boundary. EPA
                                            lacks the authority to establish Indian country land status, and is making no determination of Indian country boundaries, in this table.
                                              4 Includes any Indian country in each county or area, unless otherwise specified.




                                            *       *        *       *      *                           I. Background                                             We adopted the standard at
                                            [FR Doc. 2015–30920 Filed 12–10–15; 8:45 am]
                                                                                                           Following the publication of Federal                 § 170.210(e) as revised to include the
                                            BILLING CODE 6560–50–P
                                                                                                        Register document 2015–25597 of                         auditing of changes to user privileges in
                                                                                                        October 16, 2015 (80 FR 62602), final                   paragraph (e)(1)(i). The adopted 2015
                                                                                                        rule entitled ‘‘2015 Edition Health                     Edition ‘‘audit report(s)’’ certification
                                            DEPARTMENT OF HEALTH AND                                    Information Technology (Health IT)                      criterion references this standard.
                                            HUMAN SERVICES                                              Certification Criteria, 2015 Edition Base               Therefore, it is a ‘‘revised’’ certification
                                                                                                        Electronic Health Record (EHR)                          criterion as compared to the 2014
                                            Office of the Secretary                                                                                             Edition ‘‘audit report(s)’’ certification
                                                                                                        Definition, and ONC Health IT
                                                                                                                                                                criterion and ineligible for gap
                                                                                                        Certification Program Modifications’’
                                            45 CFR Part 170                                                                                                     certification.
                                                                                                        (hereinafter referred to as the 2015
                                            RIN 0991–AB93                                               Edition final rule), we identified a                    2. ‘‘Integrity’’ Certification Criterion
                                                                                                        number of errors in the final rule. We                     On page 62657, third column, third
                                            2015 Edition Health Information                             summarize and correct these errors in
                                            Technology (Health IT) Certification                                                                                paragraph, the last sentence incorrectly
                                                                                                        the ‘‘Summary of Errors’’ and                           references SHA–1. The commenters’
                                            Criteria, 2015 Edition Base Electronic                      ‘‘Corrections of Errors’’ sections below.               statements were specific to SHA–2.
                                            Health Record (EHR) Definition, and                            We also clarify requirements of the
                                            ONC Health IT Certification Program                         Common Clinical Data Set (CCDS), the                    3. ‘‘Accounting of Disclosures’’
                                            Modifications; Corrections and                              privacy and security certification                      Certification Criterion
                                            Clarifications                                              framework, and the mandatory                               On page 62658, first column, mid-
                                            AGENCY:   Office of the National                            disclosures for health IT developers in                 page, within the 2015 Edition
                                            Coordinator for Health Information                          the ‘‘Clarifications’’ section below.                   ‘‘accounting of disclosures’’ certification
                                            Technology (ONC), Department of                             II. Summary of Errors                                   criterion table, we inadvertently
                                            Health and Human Services (HHS).                                                                                    referenced the criterion as codified in 45
                                                                                                        A. Preamble Errors                                      CFR 170.315(d)(10), when in fact it was
                                            ACTION: Final rule; corrections and
                                                                                                        1. ‘‘Audit Report(s)’’ Certification                    codified in 45 CFR 170.315(d)(11). We
                                            clarifications.
                                                                                                        Criterion                                               note that the 2015 Edition ‘‘auditing
                                            SUMMARY:    This document corrects errors                                                                           actions on health information’’
                                            and clarifies provisions of the final rule                     We incorrectly identified the adopted                certification criterion was codified in 45
                                            entitled ‘‘2015 Edition Health                              2015 Edition ‘‘audit report(s)’’                        CFR 170.315(d)(10).
                                            Information Technology (Health IT)                          certification criterion throughout the
                                                                                                        preamble as ‘‘unchanged’’ and eligible                  4. ‘‘Transmission to Public Health
                                            Certification Criteria, 2015 Edition Base                                                                           Agencies—Antimicrobial Use and
                                            Electronic Health Record (EHR)                              for gap certification. More specifically,
                                                                                                        we identified it incorrectly:                           Resistance Reporting’’ Certification
                                            Definition, and ONC Health IT                                                                                       Criterion
                                            Certification Program Modifications.’’                         a. On page 62609, under Table 2
                                                                                                        (‘‘2015 Edition Health IT Certification                    On page 62668, third column, lines 2
                                            DATES: This correction is effective
                                                                                                        Criteria’’), as an unchanged criterion                  and 3, there was a parenthetical error
                                            January 14, 2016. The final rule                            compared to the 2014 Edition and gap                    stating that we adopted the
                                            appeared in the Federal Register on                         certification eligible.                                 ‘‘transmission to public health
                                            October 16, 2015 (80 FR 62602), and is                         b. On page 62656, second column, in                  agencies—antimicrobial use and
                                            effective on January 14, 2016, except for                   the ‘‘Response’’ under ‘‘Audit                          resistance reporting’’ certification
                                            § 170.523(m) and (n), which are                             Report(s),’’ as adopted as proposed (i.e.,              criterion as proposed (with both
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                                            effective on April 1, 2016.                                 ‘‘unchanged’’).                                         Volumes 1 and 2 of the HAI IG). The
                                            FOR FURTHER INFORMATION CONTACT:                               c. On page 62681, under Table 6                      parenthetical is corrected to not
                                            Michael Lipinski, Office of Policy,                         (‘‘Gap Certification Eligibility for 2015               reference volumes of the HL 7
                                            National Coordinator for Health                             Edition Health IT Certification                         Implementation Guide for CDA®
                                            Information Technology, 202–690–7151.                       Criteria’’), as eligible for gap                        Release 2—Level 3: Healthcare
                                            SUPPLEMENTARY INFORMATION:                                  certification.                                          Associated Infection Reports, Release 1


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                                                             Federal Register / Vol. 80, No. 238 / Friday, December 11, 2015 / Rules and Regulations                                            76869

                                            (U.S. Realm), August 9, 2013 (HAI IG).                  should not have been referenced                       capabilities is the same as the patient for
                                            This adopted version of the HAI IG does                 because there are only four paragraphs,               the purposes of testing and certification.
                                            not contain multiple volumes. Further,                  ending with paragraph (iv). Paragraph
                                                                                                                                                          7. ‘‘Consolidated CDA Creation
                                            the adopted version of the                              (ii) should not have been cross-
                                                                                                                                                          Performance’’ Certification Criterion
                                            implementation guide was incorporated                   referenced because paragraph (ii) no
                                            by reference in § 170.299(f)(26).                       longer includes a configuration                          On page 62754, second column, lines
                                            5. Common Clinical Data Set—                            capability that could be enabled. The                 42–46 (§ 170.315(g)(6)(ii)), we
                                            Assessment and Plan of Treatment,                       configuration capability included in                  inadvertently included a sentence
                                            Goals, and Health Concerns                              paragraph (ii) was intended to support                stating that the scope of this
                                                                                                    user selection among the multiple                     certification criterion will not exceed
                                               On page 62696, second column, lines                  document templates we proposed for                    the evaluation of the CCD, Referral Note,
                                            8–14, we did not clearly indicate that                  inclusion in paragraph (ii) of this                   and Discharge Summary document
                                            only the narrative parts of the ‘‘Goals                 certification criterion. In the final rule,           templates. This statement is
                                            Section’’ and ‘‘Health Concerns                         however, we only included the                         inconsistent with the preamble
                                            Section’’ needed to be met in order to                  Continuity of Care Document (CCD)                     guidance of the final rule on page
                                            meet the CCDS definition. We refer                      document template in paragraph (ii).                  62674, which states that we have
                                            readers to section III.A (‘‘Common                      Therefore, a configuration capability for             required that Consolidated CDA (C–
                                            Clinical Data Set’’) below for further                  selecting among document templates is                 CDA) creation performance be
                                            clarification of these CCDS                             no longer applicable and both the cross-              demonstrated for the C–CDA Release 2.1
                                            requirements.                                           reference to paragraph (ii) and the                   document templates required by the
                                            B. Regulation Text Errors                               inclusion of configuration language in                2015 Edition certification criteria
                                                                                                    paragraph (ii) on page 62751, first                   presented for certification. Certification
                                            1. 2015 Edition Base EHR Definition                     column, lines 10–11, are incorrect. In                to some criteria (e.g., the ‘‘transitions of
                                               On page 62742, first column, line 16                 terms of the configuration language in                care’’ criterion) requires three C–CDA
                                            (§ 170.102), we inadvertently made an                   paragraph (ii), more specifically the                 document templates whereas other
                                            error in the 2015 Edition Base EHR                      inclusion of ‘‘configuration’’ in the                 criteria (e.g., the ‘‘care plan’’ criterion)
                                            definition by citing to § 170.315(a)(15)                paragraph title is an error as is the                 only requires one C–CDA document
                                            instead of § 170.315(a)(14). As discussed               inclusion of the capability to ‘‘configure            template. To further illustrate, if a
                                            on pages 62625, 62630, 62691 and                        the technology’’ in the first sentence.               Health IT Module only included the
                                            identified on page 62692 (Table 7), we                                                                        ‘‘view, download, and transmit to 3rd
                                            included the ‘‘implantable device list’’                5. ‘‘Clinical Quality Measures—Filter’’
                                                                                                    Certification Criterion                               party’’ certification criterion
                                            certification criterion (§ 170.315(a)(14))                                                                    (§ 170.315(e)(1)) within its certificate’s
                                            in the 2015 Edition Base EHR definition                 a. Patient Insurance Standard                         scope, then only the Continuity of Care
                                            as we proposed (80 FR 16806, 16825,                                                                           Document (CCD) document template
                                                                                                      On page 62751, third column, line 22,
                                            16870–16871). We did not propose to                                                                           would be applicable within the ‘‘C–CDA
                                                                                                    we inadvertently included ‘‘at a
                                            include nor intend to include the                                                                             creation performance’’ criterion.
                                                                                                    minimum’’ language for the required
                                            ‘‘social, psychological, and behavioral                                                                       Conversely, if a Health IT Module
                                                                                                    patient insurance standard. The
                                            data’’ certification criterion                                                                                designed for the inpatient setting
                                                                                                    standard (Source of Payment Typology
                                            (§ 170.315(a)(15)) in the 2015 Edition                                                                        included the ‘‘transitions of care’’
                                                                                                    Code Set Version 5.0 (October 2011))
                                            Base EHR definition.                                                                                          certification criterion (§ 170.315(b)(1))
                                                                                                    was adopted at § 170.207(s)(1), but we
                                            2. Sexual Orientation Code                              did not adopt this standard as a                      within its certificate’s scope, then all
                                                                                                    ‘‘minimum standards’’ code set (see 80                three document templates referenced by
                                               On page 62744, third column, line 24
                                                                                                    FR 62612).                                            that criterion (CCD, Referral Note, and
                                            (§ 170.207(o)(1)(ii)), the code (20730005)
                                                                                                                                                          Discharge Summary) would need to be
                                            attributed to ‘‘straight or heterosexual’’              b. Patient Sex Standard                               evaluated as part of the ‘‘C–CDA
                                            was inaccurate. The correct code is
                                                                                                       On page 62751, third column, lines                 creation performance’’ criterion, with
                                            20430005 (emphasis added).
                                                                                                    25–26, we inadvertently included ‘‘at a               the Discharge Summary only applicable
                                            3. ‘‘Implantable Device List’’                          minimum’’ language for the required                   to the inpatient setting.
                                            Certification Criterion                                 patient sex standard. The standard for                8. ‘‘Direct Project’’ Certification
                                               On page 62748, third column, line 1                  representing sex is the use of specific               Criterion
                                            (§ 170.315(a)(14)), we inadvertently                    HL7 Version 3 codes and was adopted
                                            omitted the word ‘‘and’’ at the end of                  at § 170.207(n)(1). We did not adopt this                On page 62755, first column, lines 53
                                            the line. On the same page and column,                  standard as a ‘‘minimum standards’’                   through 55 (§ 170.315(h)(1)(ii)), we
                                            line 42, we inadvertently added the                     code set (see 80 FR 62612).                           inadvertently referenced the
                                            word ‘‘and’’ when the ‘‘and’’ should                                                                          ‘‘Applicability Statement for Secure
                                                                                                    6. ‘‘View, Download, and Transmit to                  Health Transport’’ in the title for
                                            have been at the end of line 47. On the                 3rd Party’’ (VDT) Certification Criterion
                                            same page and column, line 59, we                                                                             paragraph (ii) when it should have only
                                            inadvertently omitted the word ‘‘and’’ at                 On page 62753, first column, lines 37               been ‘‘Delivery Notification in Direct.’’
                                            the end of the line.                                    and 55 (§ 170.315(e)(1)(ii)), we                      9. ‘‘Direct Project, Edge Protocol, and
                                                                                                    inadvertently omitted references for a                XDR/XDM’’ Certification Criterion
                                            4. ‘‘Data Export’’ Certification Criterion              patient’s authorized representative to
                                               On page 62750, third column, line 63,                have access to the specified capabilities                On page 62755, second column, lines
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                                            we inaccurately cross-referenced                        related to the activity history log under             4 through 6 (§ 170.315(h)(2)(ii)), we
                                            paragraphs (ii) through (v) of the ‘‘data               the VDT certification criterion. As                   again inadvertently referenced the
                                            export’’ certification criterion                        discussed on page 62658 and consistent                ‘‘Applicability Statement for Secure
                                            (§ 170.315(b)(6)), when the cross-                      with references throughout the VDT                    Health Transport’’ in the title for
                                            reference should have only been to                      criterion, a patient’s authorized                     paragraph (ii) when it should have only
                                            paragraphs (iii) and (iv). Paragraph (v)                representative access to these                        been ‘‘Delivery Notification in Direct.’’


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                                            76870            Federal Register / Vol. 80, No. 238 / Friday, December 11, 2015 / Rules and Regulations

                                            10. Principles of Proper Conduct for                    any suspension if the health IT                       and coded requirements part for C–
                                            ONC–ACBs—Certified Health IT                            developer has not completed the actions               CDA), we believe that it is necessary to
                                            Mandatory Disclosures                                   necessary to reinstate the suspended                  make this interpretation explicit so as to
                                            a. 2015 Edition Certified Health IT                     certification.                                        prevent health IT developers from over-
                                                                                                                                                          interpreting this definition’s data
                                               On page 62756, third column, lines                   III. Clarifications                                   requirements to include more data than
                                            35–36 (§ 170.523(k)(1)(ii)(A)), we                      A. Common Clinical Data Set                           we had intended.
                                            inadvertently cross-referenced the
                                            wrong data from § 170.523(f)(1). We did                   In the final rule (§ 170.102), we define            B. Privacy and Security Certification
                                            not intend to cross-reference                           the CCDS to mean data expressed,                      Framework—Approach 2
                                            § 170.523(f)(1)(xvii) (certification to                 where indicated, according to specified                 Under § 170.550(h)(4)(ii), a Health IT
                                            standards used to meet a certification                  standards. For four data specified in the             Module can meet applicable 2015
                                            criterion). The required data elements                  CCDS (Unique Device Identifier(s) for a               Edition privacy and security
                                            for disclosure were intended to be                      Patient’s Implantable Device(s);                      certification criterion by demonstrating,
                                            consistent across the editions. This data               Assessment and Plan of Treatment;                     through system documentation that is
                                            is not a required data element for the                  Goals; and Health Concerns), we                       sufficiently detailed to enable
                                            mandatory disclosures for health IT                     reference specific Consolidated Clinical              integration, that the Health IT Module
                                            certified to the 2014 Edition. We did,                  Document Architecture (C–CDA)                         has implemented service interfaces for
                                            however, intend to require the                          sections. Based on subsequent                         each applicable privacy and security
                                            disclosure of § 170.523(f)(1)(xv)                       examination of this regulatory text and               certification criterion that enable the
                                            (certification to clinical quality                      early interactions with stakeholders, we              Health IT Module to access external
                                            measures), which was inadvertently                      have determined that additional                       services necessary to meet the privacy
                                            omitted but consistent with the new and                 explanation of these references is                    and security certification criterion (also
                                            previous 2014 Edition disclosure                        necessary in order to ensure health IT                known as ‘‘Approach 2’’). We clarify
                                            requirements. We also refer readers to                  developers accurately and consistently                three points about Approach 2. First, we
                                            section III.C (‘‘Mandatory Disclosures                  interpret and implement health IT                     clarify that the term ‘‘access’’ includes,
                                            for 2015 Edition Certified Health IT’’)                 functionality to our expressed                        as applicable, bi-directional interfaces
                                            below for a clarification related to the                regulatory requirements. In this regard,              with external services. For example,
                                            disclosure on information specified in                  we seek to clarify two points.                        system documentation could detail how
                                            § 170.523(f)(1)(viii).                                    First, we clarify that the references to            integration establishes a bi-directional
                                                                                                    these four specific C–CDA section                     interface that meets the requirements of
                                            b. 2014 Edition Certified Health IT                     templates is not meant to be strictly                 the 2015 Edition ‘‘audit report(s)’’
                                               On page 62756, third column, lines                   interpreted to mean that a health IT                  certification criterion. Second, external
                                            42–43 (§ 170.523(k)(1)(ii)(B)), we                      developer must use the C–CDA’s syntax                 services simply mean services outside
                                            inadvertently omitted cross-references                  for each referenced section. Such a strict            the scope of the Health IT Module being
                                            to paragraphs (f)(2)(iii) (product version)             interpretation would directly contradict              presented for certification. External
                                            and (vi) (any additional relied upon                    the flexibility we have intentionally                 services could be, but are not limited to,
                                            software used to demonstrate                            offered to health IT developers who seek              those provided by another certified
                                            compliance with a certification criterion               to certify to the ‘‘application access—               Health IT Module, another software
                                            or criteria) of § 170.523. The parallel                 data category request’’ certification                 program such as Microsoft Active
                                            requirements were included in the                       criterion adopted at 45 CFR                           Directory, or a hospital enterprise-wide
                                            required disclosures for health IT                      170.315(g)(8), which references the                   infrastructure. Third, a Health IT
                                            certified to the 2015 Edition and were                  CCDS but does not bind health IT                      Module is not required to be paired with
                                            previously required to be disclosed as                  presented for certification to solely use             the other services for the purposes of
                                            part of certification to the 2014 Edition.              the C–CDA to meet the criterion. To                   certification (e.g., certified with another
                                            10. In-the-Field Surveillance and                       avoid stakeholders inadvertently                      certified Health IT Module that
                                            Maintenance of Certification for Health                 following this overly strict                          performs the privacy and security
                                            IT                                                      interpretation, we clarify that the                   capability or specifying the external
                                                                                                    references to these C–CDA section                     services as ‘‘relied upon software’’).
                                            a. Exclusion and Exhaustion                             templates was meant (like all of the
                                               On page 62758, third column, lines 4                 other data listed in the CCDS) to                     C. Mandatory Disclosures for 2015
                                            and 10 (§ 170.556(c)(5)), we twice                      emphasize that these data need to be                  Edition Certified Health IT
                                            inadvertently cross-referenced                          consistently and independently                          We clarify that for compliance with
                                            paragraph (c)(3) of § 170.556 instead of                represented as discrete data that are                 § 170.523(k)(1)(ii)(A), the only
                                            paragraph (c)(4) of § 170.556. Paragraph                clearly distinguishable.                              information that must be disclosed to
                                            (c)(4) includes the requirements for                      Second, we clarify for the Assessment               meet the data requirement specified in
                                            locations as they would apply to the                    and Plan of Treatment, Goals, and                     § 170.523(f)(1)(viii) is the certification
                                            ‘‘exclusion and exhaustion’’                            Health Concerns data that only the                    criterion or criteria to which the Health
                                            requirements of paragraph (c)(5).                       narrative part of the referenced C–CDA                IT Module has been certified. This is
                                                                                                    section templates is necessary and                    consistent with the disclosure
                                            b. Termination                                          required in order to satisfy the CCDS.                requirements for certification to the
                                               On page 62759, second column, lines                  Further and in support of this                        2014 Edition.
                                            23–24 (§ 170.556(d)(6)), we                             clarification, testing and certification
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                                            inadvertently included language                         will focus on the presence of data                    IV. Waiver of Proposed Rulemaking
                                            suggesting that termination was limited                 represented consistent with just the                    We ordinarily publish a notice of
                                            to suspensions in the context of                        narrative part of the referenced section              proposed rulemaking in the Federal
                                            randomized surveillance. Consistent                     templates. Similar to our points above,               Register to provide a period for public
                                            with the preamble discussion on pages                   given that these section templates in the             comment before the provisions of a rule
                                            62716–62718, termination can follow                     C–CDA have two parts (a narrative part                take effect in accordance with section


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                                                             Federal Register / Vol. 80, No. 238 / Friday, December 11, 2015 / Rules and Regulations                                         76871

                                            553(b) of the Administrative Procedure                  reporting of changes in user privileges               § 170.315 2015 Edition health IT
                                            Act (APA) (5 U.S.C. 553(b)). However,                   consistent with the adopted 2015                      certification criteria.
                                            we can waive this notice and comment                    Edition ‘‘auditable events and tamper                 *      *    *     *     *
                                            procedure if the Secretary finds, for                   resistance’’ certification criterion.’’                 (a) * * *
                                            good cause, that the notice and                            3. On page 62657, third column, third                (14) * * *
                                            comment process is impracticable,                       paragraph, correct the last sentence to                 (ii) * * *
                                            unnecessary, or contrary to the public                  read ‘‘A few commenters requested that                  (A) Device Identifier; and
                                            interest, and incorporates a statement of               we wait until 2017 or 2018 to increase                *      *    *     *     *
                                            the finding and the reasons therefore in                the standard to SHA–2.’’                                (iv) * * *
                                            the notice.                                                4. On page 62658, first column, mid-                 (A) The active Unique Device
                                               In our view, this correcting and                     page, within the 2015 Edition                         Identifiers recorded for the patient;
                                            clarifying document does not constitute                 ‘‘accounting of disclosures’’ certification             (B) For each active Unique Device
                                            a rulemaking that would be subject to                   criterion table, the citation is corrected            Identifier recorded for a patient, the
                                            the APA notice and comment                              to read ‘‘45 CFR 170.315(d)(11).’’                    description of the implantable device
                                            requirements. This document corrects                       5. On page 62668, third column, lines              specified by paragraph (a)(14)(iii)(A) of
                                            errors and clarifies provisions of the                  2 and 3, correct the parenthetical to read            this section; and
                                            2015 Edition final rule published on                    ‘‘(with the HAI IG).’’
                                                                                                       6. On page 62681, Table 6, remove                  *      *    *     *     *
                                            October 16, 2015. It does not make                                                                              (v) * * *
                                            substantive changes to the policies that                ‘‘(d)(3) Audit report(s)’’ from the ‘‘2015
                                                                                                    Edition’’ column and ‘‘(d)(3) Audit                     (C) The identifiers associated with the
                                            were adopted. As a result, this                                                                               Unique Device Identifier, as specified by
                                            correcting document is intended to                      report(s)’’ from the ‘‘2014 Edition’’
                                                                                                    column.                                               paragraph (a)(14)(ii) of this section; and
                                            ensure that the final rule accurately
                                                                                                       7. On page 62696, second column,                   *      *    *     *     *
                                            reflects the policies adopted in that final
                                                                                                    lines 8–14, correct the sentence to read                (b) * * *
                                            rule.
                                               In addition, even if this were a                     ‘‘Thus, other C–CDA document                            (6) * * *
                                                                                                    templates such as CCD, Referral Note,                   (i) * * *
                                            rulemaking to which the notice and
                                                                                                    and Discharge Summary would need to                     (A) Enable a user to set the
                                            comment requirements applied, we find
                                                                                                    be able to exchange the narrative                     configuration options specified in
                                            that there is good cause to waive such
                                                                                                    information from the ‘‘Goals Section’’                paragraphs (b)(6)(iii) and (iv) of this
                                            requirements. Undertaking further
                                                                                                    and ‘‘Health Concerns Section’’ in order              section when creating an export
                                            notice and comment procedures to
                                                                                                    to meet the Common Clinical Data Set                  summary as well as a set of export
                                            incorporate the corrections in this
                                                                                                    definition.’’                                         summaries for patients whose
                                            document into the final rule would be
                                                                                                                                                          information is stored in the technology.
                                            contrary to the public interest.                        B. Regulation Text Corrections                        A user must be able to execute these
                                            Furthermore, such procedures would be
                                                                                                    ■ 1. On page 62742, first column, in                  capabilities at any time the user chooses
                                            unnecessary, as we are not altering the
                                                                                                    § 170.102, in the definition of ‘‘2015                and without subsequent developer
                                            policies that were already subject to
                                                                                                    Edition Base EHR’’, paragraph (3) is                  assistance to operate.
                                            comment and finalized in our final rule.
                                            Therefore, we believe we have good                      corrected to read as follows:                         *      *    *     *     *
                                            cause to waive the notice and comment                                                                           (ii) Creation. Enable a user to create
                                                                                                    § 170.102    Definitions.
                                            requirements.                                                                                                 export summaries formatted in
                                                                                                    *      *     *     *      *                           accordance with the standard specified
                                            V. Corrections of Errors                                   2015 Edition Base EHR * * *                        in § 170.205(a)(4) using the Continuity
                                                                                                       (3) Has been certified to the
                                            A. Preamble Corrections                                                                                       of Care Document document template
                                                                                                    certification criteria adopted by the
                                                                                                                                                          that includes, at a minimum:
                                               1. On page 62609, correct Table 2 as                 Secretary in § 170.315(a)(1), (2), or (3);
                                                                                                    (a)(5) through (9); (a)(11); (a)(14); (b)(1)          *      *    *     *     *
                                            follows:
                                               a. Remove ‘‘Audit Report(s)’’ from the               and (6); (c)(1); (g)(7) through (9); and                (c) * * *
                                            ‘‘Unchanged Criteria as Compared to the                 (h)(1) or (2);                                          (4) * * *
                                                                                                                                                            (iii) * * *
                                            2014 Edition (Gap Certification                         *      *     *     *      *
                                                                                                                                                            (E) Patient insurance in accordance
                                            Eligible)’’ category and insert it with an              ■ 2. On page 62744, third column, in                  with the standard specified in
                                            in asterisk (i.e., Audit Report(s)*) in the             § 170.207, paragraph (o)(1)(ii) is                    § 170.207(s)(1).
                                            ‘‘Revised Criteria as Compared to the                   corrected to read as follows:                           * * *
                                            2014 Edition’’ category after ‘‘Auditable
                                                                                                    § 170.207 Vocabulary standards for                      (G) Patient sex in accordance with the
                                            Events and Tamper-Resistance.’’
                                                                                                    representing electronic health information.           version of the standard specified in
                                               b. Revise the ‘‘Unchanged Criteria as
                                                                                                    *       *     *    *       *                          § 170.207(n)(1).
                                            Compared to the 2014 Edition (Gap
                                            Certification Eligible) (16)’’ title to                    (o) * * *                                          *      *    *     *     *
                                            ‘‘Unchanged Criteria as Compared to the                    (1) * * *                                            (e) * * *
                                            2014 Edition (Gap Certification Eligible)                  (ii) Straight or heterosexual.                       (1) * * *
                                            (15)’’.                                                 20430005.                                               (ii) * * *
                                               c. Revise the ‘‘Revised Criteria as                  *       *     *    *       *                            (A) When any of the capabilities
                                            Compared to the 2014 Edition (25)’’ title               ■ 3. On pages 62748 through 62755, in                 included in paragraphs (e)(1)(i)(A)
                                            to ‘‘Revised Criteria as Compared to the                § 170.315, paragraphs (a)(14)(ii)(A),                 through (C) of this section are used, the
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                                            2014 Edition (26)’’.                                    (a)(14)(iv)(A) and (B), (a)(14)(v)(C),                following information must be recorded
                                               2. On page 62656, second column, in                  (b)(6)(i)(A), (b)(6)(ii) introductory text,           and made accessible to the patient (or
                                            the ‘‘Response’’ under ‘‘Audit                          (c)(4)(iii)(E) and (G), (e)(1)(ii)(A)                 his/her authorized representative):
                                            Report(s),’’ correct the first sentence to              introductory text, (e)(1)(ii)(B), (g)(6)(ii),         *      *    *     *     *
                                            read ‘‘We have adopted this certification               (h)(1)(ii), and (h)(2)(ii) are corrected to             (B) Technology presented for
                                            criterion as revised to support the audit               read as follows:                                      certification may demonstrate


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                                            76872            Federal Register / Vol. 80, No. 238 / Friday, December 11, 2015 / Rules and Regulations

                                            compliance with paragraph (e)(1)(ii)(A)                   (2) * * *                                           ■ b. On page 62759, second column,
                                            of this section if it is also certified to the            (ii) Delivery Notification in Direct.               correct paragraph (d)(6) to read as
                                            certification criterion specified in                    Able to send and receive health                       follows:
                                            § 170.315(d)(2) and the information                     information in accordance with the
                                            required to be recorded in paragraph                                                                          § 170.556 In-the-field surveillance and
                                                                                                    standard specified in § 170.202(e)(1).                maintenance of certification for Health IT.
                                            (e)(1)(ii)(A) of this section is accessible
                                            by the patient (or his/her authorized                   § 170.523    [Corrected]                              *     *      *     *    *
                                            representative).                                                                                                (d) * * *
                                                                                                    ■ 4. In § 170.523—                                      (6) If a certified Complete EHR or
                                            *       *    *     *      *
                                                                                                    ■ a. On page 62756, third column, lines               certified Health IT Module’s
                                               (g) * * *
                                                                                                    35–36, paragraph (k)(1)(ii)(A), the                   certification has been suspended, an
                                               (6) * * *
                                                                                                    reference ‘‘paragraphs (f)(1)(i), (vi), (vii),        ONC–ACB is permitted to initiate
                                               (ii) Document-template conformance.
                                                                                                    (viii), (xvi), and (xvii) of this section’’ is        certification termination procedures for
                                            Create a data file formatted in
                                                                                                    corrected to read ‘‘paragraphs (f)(1)(i),             the Complete EHR or Health IT Module
                                            accordance with the standard adopted
                                                                                                    (vi), (vii), (viii), (xv), and (xvi) of this          (consistent with its accreditation to ISO/
                                            in § 170.205(a)(4) that demonstrates a
                                                                                                    section’’.                                            IEC 17065 and procedures for
                                            valid implementation of each document
                                            template applicable to the certification                ■ b. On page 62756, third column, lines               terminating a certification) when the
                                            criterion or criteria within the scope of               42–43, paragraph (k)(1)(ii)(B), the                   developer has not completed the actions
                                            the certificate sought.                                 reference ‘‘paragraphs (f)(2)(i), (ii), (iv)–         necessary to reinstate the suspended
                                                                                                    (v), and (vii) of this section’’ is corrected         certification.
                                            *       *    *     *      *
                                                                                                    to read ‘‘paragraphs (f)(2)(i) through (vii)          *     *      *     *    *
                                               (h) * * *
                                               (1) * * *                                            of this section’’.                                      Dated: December 7, 2015.
                                               (ii) Delivery Notification in Direct.                ■ 5. In § 170.556—                                    Madhura Valverde,
                                            Able to send and receive health                         ■ a. On page 62758, third column, lines               Executive Secretary to the Department,
                                            information in accordance with the                      4 and 10, paragraph (c)(5), correct the               Department of Health and Human Services.
                                            standard specified in § 170.202(e)(1).                  reference ‘‘paragraph (c)(3)’’ each time it           [FR Doc. 2015–31255 Filed 12–10–15; 8:45 am]
                                            *       *    *     *      *                             appears to read ‘‘paragraph (c)(4)’’.                 BILLING CODE 4150–45–P
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Document Created: 2018-03-02 09:13:01
Document Modified: 2018-03-02 09:13:01
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionRules and Regulations
ActionFinal rule; corrections and clarifications.
DatesThis correction is effective January 14, 2016. The final rule appeared in the Federal Register on October 16, 2015 (80 FR 62602), and is effective on January 14, 2016, except for Sec. 170.523(m) and (n), which are effective on April 1, 2016.
ContactMichael Lipinski, Office of Policy, National Coordinator for Health Information Technology, 202-690-7151.
FR Citation80 FR 76868 
RIN Number0991-AB93

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