EHR Standards-V2R - Task SubGrps I ,II & III-Oct-12[3]

7/25/2019 EHR Standards-V2R - Task SubGrps I ,II & III-Oct-12[3]

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Report of Sub-Group Task II (data connectivity) with reports of Sub-GroupTask I (standards) and Sub-Group Task III (data ownership) incorporated

Recommendations

On

Electronic Medical Records

StandardsIn

India


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!"EXECUTIVE SUMMARY

/LMNOPQMRL STSOLUS MRL PVWPNT QXUYNLZH [RMWUL\OL] M\] ^SL U^NOVYNL V\[XRUMOVX\ OLQP\XNXWTSTSOLUS6 5VOP _L\]XRS V\QXRYXRMOV\W ]V[[LRL\O SOM\]MR]S [XR SVUVNMR XR SMUL STSOLUSH VO VS NVOONL

`X\]LR OPMO MNNKRX^\] V\L[[VQVL\QTH `MSOL M\] LRRXRS V\ PLMNOPQMRL V\[XRUMOVX\ M\] ]LNV_LRT

UM\MWLUL\O MRL MNN OXX QXUUX\YNMQL M\ XQQ^RRL\QL6 :X\SLa^L\ONTH M patients medical

V\[XRUMOVX\ X[OL\ WLOS ORMYYL] V\ SVNXS X[ NLWMQT STSOLUSH ^\MbNL OX bL SPMRL] `VOP ULUbLRS X[

OPL PLMNOPQMRL QXUU^\VOT6 #PLSL MRL SXUL X[ OPL SL_LRMN UXOV_MOVX\S ]RV_V\W M\ L[[XRO OX

L\QX^RMWL SOM\]MR]VcMOVX\H V\OLWRMOVX\ M\] LNLQORX\VQ V\[XRUMOVX\ LZQPM\WL MUX\WSO OPL

_MRVX^S PLMNOPQMRL YRX_V]LRS6

+\ XR]LR OX bL ULM\V\W[^NH PLMNOP RLQXR] X[ M\ V\]V_V]^MN \LL]S OX bL [RXU QX\QLYOVX\ =bLOOLR>

or birth (at the very least). As one progresses through ones life, every record of every clinical

encounter represents an event in ones life. Each of these records may be insignificant or

SVW\V[VQM\O ]LYL\]V\W X\ OPL Q^RRL\O YRXbNLUS OPMO OPL YLRSX\ S^[[LRS [RXU6

%L_LNXYUL\OMN ,RVWV\S X[ /LMNOP M\] %VSLMSLS =%,/(%> PMS S^QQLSS[^NNT YRX_L\ OPL VUYXROM\QL

X[ ]L_LNXYUL\OMN RLQXR]S X[ V\]V_V]^MNS V\ YRL]VQOV\W M\]1XR LZYNMV\V\W OPL ]VSLMSLS OPMO MYLRSX\ VS S^[[LRV\W [RXU6 +\ OPL Q^RRL\O NMRWLNT YMYLRKbMSL] UL]VQMN RLQXR]S `XRN]H V\_MN^MbNL

]MOM VS UXRL X[OL\ OPM\ \XO ^\M_MVNMbNL MO OPL RVWPO OVUL V\ OPL PM\]S X[ OPL QNV\VQMN QMRL

YRX_V]LRS OX YLRUVO bLOOLR QMRL6 #PVS VS NMRWLNT ]^L OX OPL V\L[[VQVL\QVLS V\PLRL\O OX OPL YMYLRK

bMSL] STSOLU6 +\ M\ LNLQORX\VQ `XRN]H VO VS _LRT U^QP YXSSVbNLH YRX_V]L] QLROMV\ VUYXROM\O SOLYS

MRL OMdL\ bL[XRLPM\] OX L\S^RL OPL M_MVNMbVNVOT X[ OPL RVWPO V\[XRUMOVX\ MO OPL RVWPO OVUL6

+\QRLMSV\WNT VO VS bLQXUV\W LZORLULNT \LQLSSMRT OX L\S^RL OPMO OPL RVWPO V\[XRUMOVX\ V\ RVWPOa^M\OVOVLS VS M_MVNMbNL [XR OPL RVWPO YMOVL\O MO OPL RVWPO OVUL OX L\S^RL OPMO OPL YMOVL\O RLQLV_LS

RVWPO QMRLthe five Rs of information requirement.


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SOM\]MR]SH .201./0H YRLSLR_MOVX\ M\] SLQ^RVOT MSYLQOSH PLMNOPQMRL V\[XRUMOVQS SOM\]MR]SH M\]

OPL _MRVX^S QX]V\W STSOLUS VS QMRRVL] XÔ [XNNX`L] bT OPL ]LOMVNV\W X[ OPL UV\VUÛ ]MOM SLO OPMO

M\T +\]VM\ .20 U^SO PM_L6

5PVNL M\T _L\]XR UMT QPXXSL OX PM_L M\T M]]VOVX\MNNT RLNL_M\O V\[XRUMOVX\ QMYO^RL] M\]

YRLSL\OL]H MNN U^SO QX\[XRU OX OPL 2%"6 #PLRL MRL M]]VOVX\MN \XOLS OPMO MRL LSSL\OVMNNT [XR

industry and vendor guidance in designing and building an EMR. The conclusions include draft

RLQXUUL\]MOVX\S M\] [V\MN XbSLR_MOVX\S6 ( SPXRO RL[LRL\QL SLQOVX\ M\] WNXSSMRT VS M]]L] [XR

everyones benefit6

+O VS VUYXROM\O OX \XOL OPMO OPL ^SLRS X[ OPVS ]XQÛL\O MRL M]_VSL] OX YLR^SL M\] MUMNWMUMOLH

MS \LQLSSMRTH OPL _MRVX^S YRX_VSVX\S ]LOMVNL] V\ OPL 0LQXUUL\]MOVX\S X\ 4^V]LNV\LSH "OM\]MR]S

' 3RMQOVQLS [XR #LNLUL]VQV\L V\ +\]VM MS S^bUVOOL] bT %+#H 2:+#H 4X_O6 X[ +\]VM OX 2X/'-5H

4X_O6 X[ +\]VMH V\ g^NT ?88@6?

+\ QX\QN^SVX\H VO U^SO bL M]]L] OPMO OPLSL SOM\]MR]S QM\\XO bL QX\SV]LRL] LVOPLR V\ VSXNMOVX\ XR

as etched in stone for all eternity. These will need to undergo periodic (at a maximum of 12

months interval) review and update as necessary. This document must be a living document.


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$"BACKGROUND/LMNOP :MRL SLQOXR V\ +\]VM PMS `VO\LSSL] SVW\V[VQM\O WRXÒP ]^RV\W OPL NMSO [L` TLMRSH bXOP V\

a^MNVOT M\] QMYMQVOT6 0LNMOV_LNT NX`LR QXSO X[ PLMNOP QMRLH MS QXUYMRL] OX ]L_LNXYL] QX^\ORVLSH

QX^YNL] `VOP V\OLR\MOVX\MN a^MNVOTH PMS YXSVOVX\L] +\]VM MS M UMhXR ]LSOV\MOVX\ [XR PLMNOP QMRL

SLR_VQLS6 +\ SYVOL X[ S^QP ]L_LNXYUL\OSH PLMOP QMRL [MQVNVOVLS V\ OPL QX^\ORT RLUMV\ V\M]La^MOL

OX ULLO OPL \LL]S X[ OPL QVOVcL\SH YMROVQ^NMRNT V\ R^RMN MRLMSH `PLRL MYYRXZVUMOLNT @8i X[ OPL

YLXYNL NV_L6

#X M]]RLSS OPLSL YRXbNLUSH OPL WX_LR\UL\O PMS NM^\QPL] UMhXR \MOVX\MN V\VOVMOV_LS S^QP MS

)MOVX\MN 0^RMN /LMNOP 2VSSVX\H LSOMbNVSPUL\O X[ SVZ \L` (++2" NVdL V\SOVOÔVX\SH ^Y WRM]MOVX\ X[LZVSOV\W Y^bNVQ PXSYVOMNS M\] NMbSH LOQ6 2M\MWLUL\O X[ QXUU^\VQMbNL MS `LNN MS \X\K

QXUU^\VQMbNL ]VSLMSLS PMS MNSX bLL\ M UMhXR MRLM X[ QX\QLR\ OX OPL WX_LR\UL\O6 (\

+\OLWRMOL] %VSLMSL "^R_LVNNM\QL 3RXWRMU =+%"3> VS MNRLM]T ^\]LR VUYNLUL\OMOVX\6 #PL )X\K

QXUU^\VQMbNL %VSLMSL 0VSd -MQOXR "^R_LVNNM\QL ^\]LR +%"3 `VNN ORMQd ORL\]S X[ SLNLQOL] UMhXR

RVSd [MQOXRS V\ OPL ^RbM\ M\] R^RMN YXY^NMOVX\H MWL] bLO`LL\ 7; M\] F9 TLMRS6 +\\X_MOV_L

STSOLUS MRLH PX`L_LRH RLa^VRL] [XR a^VQd RLYXROV\W X[ S^QP V\QV]L\OS `PL\ OPLT XQQ^R M\] OX

VUYNLUL\O M\ L[[LQOV_L STSOLU X[ V\OLR_L\OVX\ OX YRX_V]L OPL bLSO ]VMW\XSOVQ M\] UL]VQMN QMRLOX OPL M[[LQOL] YMOVL\OS M\] YRL_L\O [^ROPLR SYRLM] X[ OPL ]VSLMSL6

+\]VM MNSX PMS M SORX\W bMSL [XR UL]VQMN RLSLMRQP6 .ZOL\SV_L `XRd VS bLV\W ]X\L MS M YMRO X[

YXSOWRM]^MOL `XRd V\ UL]VQMN V\SOVOÔVX\SH +:20 NMbS M\] XOPLR V\SOVOÔVX\S6 #PLRL VSH PX`L_LRH

M SORX\W \LL] X[ SPMRV\W X[ d\X`NL]WL M\] RLSX^RQLS MUX\WSO OPL RLSLMRQPLRS M\] PLMNOPQMRL

YRX_V]LRS6

+\ M]]VOVX\H YRV_MOL SLQOXR PMS V\VOVMOL] UMSSV_L V\_LSOUL\OS V\ _MRVX^S [MQLOS X[ PLMNOPQMRL6 #PVS

VS LZYLQOL] OX YXSVOVX\ PLMNOP QMRL MS X\L X[ OPL NMRWLSO SLR_VQL SLQOXRS M\] M SVW\V[VQM\O

QX\ORVbÔXR OX OPL 4%36 (S OPL PLMNOP SLQOXR VS YXVSL] [XR UMhXR WRXÒP V\ \LZO ]LQM]LH OPL


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RLNVMbVNVOTH M\] MQQ^RMQT MRL QRVOVQMN [MQOXRS V\ XbOMV\V\W OPL OR^SO X[ SOMdLPXN]LRSH V\QN^]V\W

QX\SÛLRSH M\] V\ S^SOMV\V\W NX\WKOLRU ]MOM LZQPM\WL X\ M NMRWL SQMNL6C

.NLQORX\VQ PLMNOP RLQXR]S QM\ VUYRX_L QMRL bT L\MbNV\W [^\QOVX\S OPMO YMYLR UL]VQMN RLQXR]S

QM\\XO ]LNV_LRB

EHRs can make a patients health information available when and where it is needed

OXX X[OL\ QMRL PMS OX `MVO bLQM^SL OPL QPMRO VS V\ X\L YNMQL M\] \LL]L] V\ M\XOPLR6 ./0S

L\MbNL QNV\VQVM\S SLQ^RL MQQLSS OX V\[XRUMOVX\ \LL]L] OX S^YYXRO PVWP a^MNVOT M\]

L[[VQVL\O QMRL6

EHRs can bring a patients total health information together to support better healthQMRL ]LQVSVX\SH M\] UXRL QXXR]V\MOL] QMRL6

./0S QM\ S^YYXRO bLOOLR [XNNX`K^Y V\[XRUMOVX\ [XR YMOVL\OS[XR LZMUYNLH M[OLR M QNV\VQMN

_VSVO XR PXSYVOMN SOMTH V\SOR^QOVX\S M\] V\[XRUMOVX\ [XR OPL YMOVL\O QM\ bL L[[XRONLSSNT

YRX_V]L] M\] RLUV\]LRS [XR XOPLR [XNNX`K^Y QMRL QM\ bL SL\O LMSVNT XR L_L\

MÔXUMOVQMNNT OX OPL YMOVL\O6

./0S QM\ VUYRX_L YMOVL\O M\] YRX_V]LR QX\_L\VL\QL YMOVL\OS QM\ PM_L OPLVR

prescriptions ordered and ready even before they leave the providers office, and

V\S^RM\QL QNMVUS QM\ bL [VNL] VUUL]VMOLNT [RXU OPL YRoviders office.;

+O `X^N] QLROMV\NT \XO bL XÔ X[ YNMQL OX UL\OVX\ PLRL OPMO VO `VNN bL YMROVQ^NMRNT ^SL[^N OX RL_VL` 9;

:-0 3MRO 7F9 [XR "LQ^RVOT M\] 3RV_MQT MSYLQOS MSSXQVMOL] `VOP ./01.20 ]LSVW\H ]L_LNXYUL\OH

VUYNLUL\OMOVX\H UMV\OL\M\QL M\] ^SLH MS `LNN MS 9; :-0 7F8 [XR M]UV\VSORMOV_L RLa^VRLUL\OS

MSSXQVMOL] VOP QX]L SLOSH ]MOM L\ORT [XRUMOS M\] SOM\]MR] \Va^L V]L\OV[VLRS6


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%"MAJOR STAKEHOLDERS

:VOVcL\S

/LMNOP QMRL YRX_V]LRS M\] YMTLRS

.]^QMOVX\H RLSLMRQP V\SOVOÔVX\S M\] V\_LSOVWMOXRS

4X_LR\UL\O ]LYMROUL\OS M\] V\SOVOÔVX\S

3^bNVQ PLMNOP MWL\QVLS M\] )4,S

3PMRUMQLÔVQMN V\]^SORT M\] UL]VQMN ]L_VQL UMdLRS

#LNLUL]VQV\L V\SOVOÔVX\S

"X[O`MRL M\] PMR]`MRL _L\]XRS


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&"ELECTRONIC HEALTH RECORDS/ELECTRONIC MEDICAL

RECORDS

(QQXR]V\W OX OPL j+\OLWRMOL] :MRL ./0jH MS ]L[V\L] V\ +",1%#0 ?8;79H M\ KFJ =( 4 -*:6(=56-E

6H =.H6-


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)LOPLRNM\]S (,0#(

"V\WMYXRL .20E

"`L]L\ )MOVX\MN 3MOVL\O "^UUMRT =)3,>

#MV`M\ /LMNOP +\[XRUMOVX\ )LO`XRd =/+)>

Table 1: Worldwide HCIT Programs

@'"10&G$X>,5 \,+T5 '; !0+12+&2,

Table 2: Country-wise HCIT Standards Usage


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@'"10&G$X>,5 \,5 '; UVRD+1T5 !0+12+&2,


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@'"10&G$X>,5 !0+0>,0>R, '; !0+12+&2, K2'(0>'1


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'"INTEROPERABILITY AND STANDARDS

#PL RLQXUUL\]MOVX\S XÔNV\L] V\ OPVS SLQOVX\ MRL M\ V\QRLUL\OMN MYYRXMQP OX M]XYOV\WSOM\]MR]SH VUYNLUL\OMOVX\ SYLQV[VQMOVX\SH M\] QRVOLRVM OX L\PM\QL OPL V\OLRXYLRMbVNVOTH

[^\QOVX\MNVOTH ÔVNVOTH M\] SLQ^RVOT X[ PLMNOP V\[XRUMOVX\ OLQP\XNXWT M\] OX S^YYXRO VOS

`V]LSYRLM] M]XYOVX\6 +O VS OX bL dLYO V\ UV\] OPMO OPLSL SOM\]MR]S SPX^N] bL [NLZVbNL M\]

UX]V[VMbNL OX M]MYO OX OPL ]LUXWRMYPVQ M\] RLSX^RQL _MRVM\QL XbSLR_L] V\ M NMRWL M\]

]L_LNXYV\W QX^\ORT NVdL +\]VM6

+O VS VUYXROM\O OX RLQXW\VcL OPMO V\OLRXYLRMbVNVOT M\] SOM\]MR]VcMOVX\ QM\ XQQ^R MO UM\T

]V[[LRL\O NL_LNS6 #X MQPVL_L V\OLRXYLRMbVNVOTH V\[XRUMOVX\ UX]LNS `X^N] \LL] OX bL PMRUX\VcL]

V\OX M QX\SVSOL\O RLYRLSL\OMOVX\6=J>

+\ XOPLR QMSLSH XRWM\VcMOVX\S UMT ^SL OPL SMUL V\[XRUMOVX\ UX]LNH bÔ ^SL ]V[[LRL\O

_XQMb^NMRVLS XR QX]L SLOS =[XR LZMUYNLH "TSOLUMOVcL] )XUL\QNMO^RL X[ 2L]VQV\L :NV\VQMN #LRUS

="),2.% :#k> XR +:%78K:2 `VOPV\ OPXSL V\[XRUMOVX\ UX]LNS6 #X MQPVL_L V\OLRXYLRMbVNVOT MO

OPVS NL_LNH SOM\]MR]VcV\W _XQMb^NMRVLSH XR UMYYV\W bLO`LL\ ]V[[LRL\O _XQMb^NMRVLS =^SV\W OXXNS

NVdL $\V[VL] 2L]VQMN *M\W^MWL "TSOLU =$2*">> UMT bL \LQLSSMRT6 -XR SXUL NL_LNSH =S^QP MS OPL\LO`XRd ORM\SYXRO YRXOXQXN>H M\ V\]^SORT SOM\]MR] OPMO VS `V]LNT ^SL] =L6W6 #RM\SUVSSVX\ :X\ORXN

3RXOXQXN =#:3> M\] OPL +\OLR\LO 3RXOXQXN =+3>H =#:31+3>> `VNN NVdLNT bL OPL UXSO MYYRXYRVMOL6

$NOVUMOLNTH OX MQPVL_L SLUM\OVQ V\OLRXYLRMbVNVOTH VO VS M\OVQVYMOL] OPMO U^NOVYNL NMTLRS\LO`XRd

ORM\SYXROMOVX\ YRXOXQXNSH ]MOM M\] SLR_VQLS ]LSQRVYOVX\SH V\[XRUMOVX\ UX]LNSH M\] _XQMb^NMRVLS

M\] QX]L SLOS `VNN \LL] OX bL SOM\]MR]VcL] M\]1XR PMRUX\VcL] OX YRX]^QL M\ V\QN^SV_LH

QX\SVSOL\O RLYRLSL\OMOVX\ X[ OPL V\OLRXYLRMbVNVOT RLa^VRLUL\OS6

+O VS [^ROPLR M\OVQVYMOL] OPMO ^SV\W M PMRUX\VcMOVX\ YRXQLSS `VNN V\OLWRMOL ]V[[LRL\O

RLYRLSL\OMOVX\S X[ PLMNOP QMRL V\[XRUMOVX\ V\OX M QX\SVSOL\O RLYRLSL\OMOVX\ M\] UMV\OMV\ M\]

^Y]MOL OPMO QX\SVSOL\O RLYRLSL\OMOVX\ X_LR OVUL6 -XR M\ V\[XRUMOVX\ UX]LNH OPVS YRXQLSS QX^N]


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3RXUXOL OLQP\VQMN V\\X_MOVX\ SV\W M]XYOL] SOM\]MR]S

.\QX^RMWL YMROVQVYMOVX\ M\] M]XYOVX\ bT MNN _L\]XRS M\] SOMdLPXN]LRS

ILLY VUYNLUL\OMOVX\ QXSOS MS NX` MS RLMSX\MbNT YXSSVbNL :X\SV]LR bLSO YRMQOVQLSH LZYLRVL\QLSH YXNVQVLS M\] [RMUL`XRdS

#X OPL LZOL\O YXSSVbNLH M]XYO SOM\]MR]S OPMO MRL UX]^NMR M\] \XO V\OLR]LYL\]L\O6

F82C@


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Content Exchange Standards=V6L6H SOM\]MR]S ^SL] OX SPMRL QNV\VQMN V\[XRUMOVX\ S^QP MS QNV\VQMN SÛUMRVLSH YRLSQRVYOVX\SH M\]

SOR^QO^RL] LNLQORX\VQ ]XQÛL\OS>M> /LMNOP *L_LN "L_L\ =/*@> :NV\VQMN %XQÛL\O (RQPVOLQO^RLB VS M\ E2*KbMSL] UMRd^Y SOM\]MR]

V\OL\]L] OX SYLQV[T OPL L\QX]V\WH SOR^QO^RL M\] SLUM\OVQS X[ QNV\VQMN ]XQÛL\OS [XR

LZQPM\WL6 :%( VS bLV\W ^SL] MNSX V\ LNLQORX\VQ PLMNOP RLQXR]S YRXhLQOS OX YRX_V]L M SOM\]MR]

[XRUMO [XR L\ORTH RLORVL_MN M\] SOXRMWL X[ PLMNOP V\[XRUMOVX\

b> /*@ ?6;67B ]L[V\LS M SLRVLS X[ LNLQORX\VQ ULSSMWLS OX S^YYXRO M]UV\VSORMOV_LH NXWVSOVQMNH

[V\M\QVMN MS `LNN MS QNV\VQMN YRXQLSSLS M\] UXSONT ^SLS M OLZO^MNH \X\KE2* L\QX]V\W ST\OMZ

bMSL] X\ ]LNVUVOLRS6 /*@ _?6Z PMS MNNX`L] [XR OPL V\OLRXYLRMbVNVOT bLO`LL\ LNLQORX\VQ3MOVL\O (]UV\VSORMOVX\ "TSOLUS =3(">H .NLQORX\VQ 3RMQOVQL 2M\MWLUL\O =.32> STSOLUSH

*MbXRMOXRT +\[XRUMOVX\ "TSOLUS =*+">H %VLOMRTH 3PMRUMQT M\] GVNNV\W STSOLUS MS `LNN MS

.NLQORX\VQ 2L]VQMN 0LQXR] =.20> XR .NLQORX\VQ /LMNOP 0LQXR] =./0> STSOLUS

Q> :X\OV\^VOT X[ :MRL 0LQXR] =::0> VS M PLMNOP RLQXR] SOM\]MR] SYLQV[VQMOVX\ ]L_LNXYL] hXV\ONT

bT ("#2 +\OLR\MOVX\MNH OPL 2MSSMQP^SLOOS 2L]VQMN "XQVLOT =22">H OPL /LMNOPQMRL

+\[XRUMOVX\ M\] 2M\MWLUL\O "TSOLUS "XQVLOT =/+2"">H OPL (ULRVQM\ (QM]LUT X[ -MUVNT

3PTSVQVM\S =((-3>H OPL (ULRVQM\ (QM]LUT X[ 3L]VMORVQS =((3>H M\] XOPLR PLMNOP V\[XRUMOVQS

_L\]XRS6 +O VS M QXRL ]MOM SLO X[ OPL UXSO RLNL_M\O M]UV\VSORMOV_LH ]LUXWRMYPVQH M\] QNV\VQMN

V\[XRUMOVX\ [MQOS MbXÔ M YMOVL\OmS PLMNOPQMRLH QX_LRV\W X\L XR UXRL PLMNOPQMRL

L\QX^\OLRS6 +O YRX_V]LS M ULM\S [XR X\L PLMNOPQMRL YRMQOVOVX\LRH STSOLUH XR SLOOV\W OX

MWWRLWMOL MNN X[ OPL YLROV\L\O ]MOM MbXÔ M YMOVL\O M\] [XR`MR] VO OX M\XOPLR YRMQOVOVX\LRH

STSOLUH XR SLOOV\W OX S^YYXRO OPL QX\OV\^VOT X[ QMRL6 #PL YRVUMRT ^SL QMSL [XR OPL ::0 VS OX

YRX_V]L M S\MYSPXO V\ OVUL QX\OMV\V\W OPL YLROV\L\O QNV\VQMNH ]LUXWRMYPVQH M\]

M]UV\VSORMOV_L ]MOM [XR M SYLQV[VQ YMOVL\O6 #X L\S^RL V\OLRQPM\WLMbVNVOT X[ LNLQORX\VQ ::0SH

OPVS SYLQV[VQMOVX\ SYLQV[VLS E2* QX]V\W OPMO VS RLa^VRL] `PL\ OPL ::0 VS QRLMOL] V\ MSOR^QO^RL] LNLQORX\VQ [XRUMO6 :X\]VOVX\S X[ SLQ^RVOT M\] YRV_MQT [XR M ::0 V\SOM\QL U^SO bL

LSOMbNVSPL] V\ M `MT OPMO MNNX`S X\NT YRXYLRNT MÔPL\OVQMOL] M\] MÔPXRVcL] MQQLSS OX OPL

::0 ] O V O VO N O #P ::0 V O [ OP O OP


17/79

!WK:H XRVWV\MNNT ]L[V\L] MS mm"VUYNL ,bhLQO (QQLSS 3RXOXQXNmmH VS M YRXOXQXN SYLQV[VQMOVX\ [XR

LZQPM\WV\W SOR^QO RL] V\[XRUMOVX\ V\ OPL VUYNLUL\OMOVX\ X[ 5Lb "LR_VQLS V\ QXUY^OLR

\LO`XRdS6 +O RLNVLS X\ .ZOL\SVbNL 2MRd^Y *M\W^MWL =E2*> MS VOS ULSSMWL [XRUMOH M\] ^S^MNNTRLNVLS X\ XOPLR (YYNVQMOVX\ *MTLR YRXOXQXNS =UXSO \XOMbNT 0LUXOL 3RXQL]^RL :MNN =03:> M\]

/TYLR#LZO #RM\S[LR 3RXOXQXN =/##3>> [XR ULSSMWL \LWXOVMOVX\ M\] ORM\SUVSSVX\6 ",(3 QM\ [XRU

OPL [X^\]MOVX\ NMTLR X[ M `Lb SLR_VQLS YRXOXQXN SOMQdH YRX_V]V\W M bMSVQ ULSSMWV\W [RMUL`XRd

^YX\ `PVQP `Lb SLR_VQLS QM\ bL b^VNO6 #PL ",(3 MRQPVOLQO^RL QX\SVSOS X[ SL_LRMN NMTLRS X[

SYLQV[VQMOVX\S [XR ULSSMWL [XRUMOH ULSSMWL LZQPM\WL YMOOLR\S =2.3>H \]LRNTV\W ORM\SYXRO

YRXOXQXN bV\]V\WSH ULSSMWL YRXQLSSV\W UX]LNSH M\] YRXOXQXN LZOL\SVbVNVOT6

Privacy and Security StandardsP"Q"R S//=5=6.43 =.H6-6 #PL ULUbLRS X[ S^bK

WRX^Y #MSd ++ [V\] VO `XROPT L\X^WP OX RLQXUUL\] OPMO OPLSL bL OMdL\ V\OX QX\SV]LRMOVX\ `VOP

S^[[VQVL\O `LVWPOMWL ]^RV\W [V\MNVcMOVX\ X[ OPL RLa^VRLUL\OS RLNMOL] OX OPLSL YXV\OS6

-XR LZMUYNLH M^OPL\OVQMOVX\H MQQLSS QX\ORXNH ORM\SUVSSVX\ SLQ^RVOTH `PVQP RLNMOL OX M\] SYM\

MQRXSS MNN X[ OPL XOPLR OTYLS X[ RLNMOL] SOM\]MR]S6

C'X

b:"&(',5 K2'(052 !0+12+&2
http://aspe.hhs.gov/admnsimp/nprm/sec13.htmhttp://aspe.hhs.gov/admnsimp/nprm/sec13.htmhttp://aspe.hhs.gov/admnsimp/nprm/sec13.htm


18/79

9

0LQXR] #RLMOUL\OH 3MTUL\OH

M\] /LMNOP :MRL ,YLRMOVX\S

%VSQNXS^RLS

#PL ]MOLH OVULH YMOVL\O V]L\OV[VQMOVX\ =\MUL XR

\ÛbLR>H ^SLR V]L\OV[VQMOVX\ =\MUL XR \ÛbLR>H M\] M

]LSQRVYOVX\ X[ OPL ]VSQNXS^RL U^SO bL RLQXR]L]6

Table 5: Privacy & Security Standards

3RX_VSVX\S ^\]LR ./0 2LM\V\W[^N $SL n9; :-0o

#PL [XNNX`V\W MRL OPL YRX_VSVX\S ]LOMVNL] V\ OPL ]XQÛL\O6

MS SYLQV[VL] bT OPL )MOVX\MN

+\SOVOÔL X[ "OM\]MR]S M\] #LQP\XNXWT =)+"#> V\ -+3" 3$G 7J8C =,QOXbLRH

?88J>> U^SO bL ^SL] OX _LRV[T OPMO LNLQORX\VQ PLMNOP V\[XRUMOVX\ PMS \XO

bLL\ MNOLRL]

0LQXR] ORLMOUL\OH YMTUL\OH

M\] PLMNOP QMRL XYLRMOVX\S

]VSQNXS^RLS

#PL ]MOLH OVULH YMOVL\O V]L\OV[VQMOVX\H ^SLR V]L\OV[VQMOVX\H M\] M

]LSQRVYOVX\ X[ OPL ]VSQNXS^RL U^SO bL RLQXR]L] [XR ]VSQNXS^RLS [XR

ORLMOUL\OH YMTUL\OH M\] PLMNOP QMRL XYLRMOVX\SH MS OPLSL OLRUS MRL]L[V\L] MO 9; :-0 7F96;87

(QQLSS QX\ORXN

(SSVW\ M \Va^L \MUL M\]1XR \ÛbLR [XR V]L\OV[TV\W M\] ORMQdV\W SLR

V]L\OVOT M\] LSOMbNVSP QX\ORXNS OPMO YLRUVO X\NT MÔPXRVcL] ^SLRS OX MQQLSS


19/79

V\[XRUMOVX\

4L\LRMN L\QRTYOVX\.\QRTYO M\] ]LQRTYO LNLQORX\VQ PLMNOP V\[XRUMOVX\ ^\NLSS VO VS ]LOLRUV\L]OPMO OPL SL X[ S^QP MNWXRVOPU X^N] YXSL M SVW\V[VQM\O SLQ^RVOT RVSd [XR

:LROV[VL] ./0 #LQP\XNXWT

.\QRTYOVX\ `PL\ LZQPM\WV\W

LNLQORX\VQ PLMNOP V\[XRUMOVX\.\QRTYO M\] ]LQRTYO LNLQORX\VQ PLMNOP V\[XRUMOVX\ `PL\ LZQPM\WL]

,YOVX\MN

(QQX^\OV\W X[ ]VSQNXS^RLSB 0LQXR] ]VSQNXS^RLS UM]L [XR ORLMOUL\OH

YMTUL\OH M\] PLMNOP QMRL XYLRMOVX\S

#PL ]MOLH OVULH YMOVL\O V]L\OV[VQMOVX\H ^SLR V]L\OV[VQMOVX\H M\] M

]LSQRVYOVX\ X[ OPL ]VSQNXS^RL U^SO bL RLQXR]L] [XR ]VSQNXS^RLS [XR

ORLMOUL\OH YMTUL\OH M\] PLMNOP QMRL XYLRMOVX\S

#LRUV\XNXWVLS M\] QNMSSV[VQMOVX\S MRL V\OLWRMN OX UL]VQMN RLSLMRQPH Y^bNVQ PLMNOP RLYXROV\WH M\]

PLMNOPQMRL YMTUL\O M\MNTSVS6 #PLT MRL LSSL\OVMN OX MQPVL_L V\OLRXYLRMbVNVOT [XR M S^QQLSS[^N

+\]VM `V]L PLMNOP V\[XRUMOVX\ STSOLU OPMO RLS^NOS V\ V\QRLMSL] YMOVL\O SM[LOT6

F9;7;H89 ,28748?4::NV\VQMN SOM\]MR]S MRL PLMNOP V\[XRUMOVX\ SOM\]MR]S OX QMYO^RL M YMOVL\OmS PLMNOP V\[XRUMOVX\ V\

M UXRL QXPLRL\O UM\\LR6 #PVS PLMNOP V\[XRUMOVX\ QM\ V\QN^]L MNN XR YMRO OPLRLX[ MS RLNL_M\O X[

OPL [XNNX`V\WB

#PL VNN\LSS M YMOVL\O VS S^[[LRV\W [RXU

#PL YPTSVQVM\mS XbSLR_MOVX\ X[ OPL YMOVL\OmS VNN\LSS

The diagnostic tests that need to be carried out to ascertain the patients illness and to give

OPL YMOVL\O bLOOLR ORLMOUL\O #PL RLS^NOS X[ OPL ]VMW\XSOVQ OLSOS

#PL dV\] X[ ORLMOUL\O OX bL WV_L\ OX OPL YMOVL\O

#P OP O O O P N] b V O OP OV O


20/79

SLQX\]MRTH `PLRL OPL

YRVUMRT VS M\ V\OLR\MN

^\Va^L PLMNOP V]L\OV[VLR^SL] bT OPL PLMNOPQMRL

YRX_V]LR XRWM\VSMOVX\

E2* =LEOL\SVbNL 2MRd^Y

*M\W^MWL>

[XR ]MOM QMYO^RLH V\OLWRMOVX\ M\]

YRLSL\OMOVX\ NMTLR

#X MQQLSS _VM ",(3K

SVUYNL XbhLQO MQQLSS

YRXOXQXN

/*@ :%( =ZUN> :NV\VQMN %XQ^UL\O (RQPVOLQO^RL

::0 =("#2> :NV\VQMN %MOM [XR L\OLRYRVSLS NVdLNTOX bL ^SL] bT XRWM\VcMOVX\S OPMO

PM_L \XO TLO M]XYOL] M\T SOM\]MR]

=L6W6H LMRNT SOMWL QXUYM\VLS>H OX

S^YYXRO \L` b^SV\LSS UX]LNSH V\

]VSR^YOV_L MYYNVQMOVX\S OPMO

MQPVL_L QXSO SM_V\WS M\]1XR a^MNVOT

VUYRX_LUL\OS bT QRLMOV\W ).5

30,:.""."H X[OL\ V\_XN_V\W YMROVLS

OPMO MRL \XO Q^RRL\ONT LZQPM\WV\W

V\[XRUMOVX\

(S VO VS LZYRLSSL] V\ OPLSOM\]MR] ]MOM

V\OLRQPM\WL NM\W^MWL

d\X`\ MS E2*H VO QM\

YXOL\OVMNNT bL QRLMOL]H

RLM] M\] V\OLRYRLOL] bT

M\T ./0 XR .20

SX[O`MRL MYYNVQMOVX\

::% =/*@> :NV\VQMN %MOM [XR +\OLR %LYMROUL\O

]XQ^UL\OS =OPL :%( ::%>

*VdLNT OX bL ^SL] bT

XRWM\VcMOVX\S OPMO

MNRLM]T ^SL /*@ [XR

YRXQLSSLS +)#.0)(* #,

#/. ,04()+p(#+,) =XR`VOP LZVSOV\W ORM]V\W

YMRO\LRS>H L6W6H PXSYVOMNS

] N


21/79

:NMSSV[VQMOVX\1)%: K

\MOVX\MN ]R^W QNMSSV[VQMOVX\H

-%GK[VRSO ]MOMbM\d =$"(>+\]VM\ %R^WS 2+2"1:+2"

[RXU :23UL]VQM

]R^W RL[LRL\QL ]MOMbMSL6

#PL 5/, %R^W

%VQOVX\MRT UMT bL MWXX] QPXVQL OX bLWV\

`VOP

%VQOVX\MRT X[ 2L]VQV\L '

%L_VQLSH $I

2L]VQV\LS ' 2L]VQMN ]L_VQLS $I SOM\]MR] ^SL] V\ )/"

V\QN^]LS ]L_VQLS ' ]R^WS

*,+): :NV\VQMN *MbXRMOXRT ,bSLR_MOVX\S 3^bNVSPL] M\]

UMV\OMV\L] bT OPL

0LWL\SORVL[ +\SOVO^OLH$"(H OPVS VS M\ ^\V_LRSMNNT

MQQLYOL] QX]L [XR

NMbXRMOXRT XbSLR_MOVX\S

/*@ A?6Z XR C68 2LSSMWV\W (S /*@ VS SOVNN \XO `V]LNT

YRLSL\O V\ +\]VMH YRXYXSL

SOMRO `VOP _LRSVX\ C

/*@ AC68 0+2 0L[LRL\QL +\[XRUMOVX\ 2X]LN

%+:,2 C68 2L]VQMN +UMWLS

:3# 9 XR ;H $" 3RXQL]^RL ' #PLRMYT QNMSSV[VQMOVX\

,3:"9H $I 3RXQL]^RL ' #PLRMYT QNMSSV[VQMOVX\

"),2.%K:# :NV\VQMN #LRUV\XNXWT

5/, +:% 78 %VSLMSL QNMSSV[VQMOVX\

5/,3:" 3RXQL]^RL QX]V\W STSOLU

5/,+:- +\OLR\MOVX\MN QNMSSV[VQMOVX\ X[

[^\QOVX\V\WH ]VSMbVNVOT ' PLMNOP

84$/1 C

%"2 3STQPVMORVQ QX\]VOVX\S %VMW\XSOVQ ' SOMOVSOVQMN


22/79

)MOVX\MN 0LQXUUL\]MOVX\S [XR

/LMNOP +\[XRUMOVX\

+\[RMSOR^QO^RL V\ +\]VM

+\[XRUMOVX\ #LQP\XNXWT +\[RMSOR^QO^RL [XR /LMNOP =+#+/>

[RMUL`XRd

0LQXUUL\]MOVX\S X\ 4^V]LNV\LSH "OM\]MR]S ' 3RMQOVQLS [XR#LNLUL]VQV\L V\ +\]VM

+\]VM\ PLMNOP V\[XRUMOVX\ \LO`XRd ]L_LNXYUL\O =V/+)%>

RLQXUUL\]MOVX\S [RXU OPL )MOVX\MN I\X`NL]WL

+\OLR\MOVX\MN ,RWM\VcMOVX\ [XR

"OM\]MR]VcMOVX\ =+",>

0La^VRLUL\OS [XR .NLQORX\VQ /LMNOP 0LQXR] (RQPVOLQO^RL =.!W _ *!

8dH`d>

.^RXYLM\ :XUUVOOLL [XR

"OM\]MR]VcMOVX\ =:.)>

:.) 1 #: ?;7 UE 8HQ`Q

:X]L X[ -L]LRMN 0LW^NMOVX\S

=:-0>

/LMNOP +\[XRUMOVX\ #LQP\XNXWT "OM\]MR]SH +UYNLUL\OMOVX\

"YLQV[VQMOVX\SH M\] :LROV[VQMOVX\ :RVOLRVM M\] :LROV[VQMOVX\ 3RXWRMUS

[XR /LMNOP +\[XRUMOVX\ #LQP\XNXWT =*>0F5 JM? :+&0 8Z`>

(ULRVQM\ "XQVLOT [XR #LSOV\W '

2MOLRVMNS =("#2>

:X\OV\^VOT X[ :MRL 0LQXR] =@@C>

/LMNOP *L_LN @ =/*@> /*@ _?6Z

/*@ _C

/*@ :NV\VQMN %XQ^UL\O (RQPVOLQO^RL =:%(>

./0 K "TSOLU -^\QOVX\MN 2X]LN

/*@ ' ("#2 :XNNMbXRMOVX\ :X\OV\^VOT X[ :MRL %XQ^UL\O =@@

)MOVX\MN .NLQORVQMN

Manufacturers Association

=).2(>

%VWVOMN +UMWV\W M\] :XUU^\VQMOVX\S V\ 2L]VQV\L =

,[[VQL X[ )MOVX\MN :XXR]V\MOXR

[XR /LMNOP +\[XRUMOVX\

#LQP\XNXWT =,):/+#> $\VOL]

./0 2LM\V\W[^N $SL


23/79

("EMR MINIMUM DATA SET (MDS)#PL [XNNX`V\W 2%" VS RLQXUUL\]L] [XR M\ .20 OX bL ^SL] V\ +\]VM6 AL\]XRS MRL [RLL M\]

V\]LL] L\QX^RMWL] OX XYO [XR M]]VOVX\MN ]MOM OX SMOVS[T ^\ULO ]LUM\]S X[ OPL _MRVX^S

SOMdLPXN]LRSH YRV\QVYMNNT OPL YMOVL\OS M\] OPL QNV\VQMN QMRL YRX_V]LRS6

#PVS RLQXUUL\]MOVX\ MNSX QX_LRS _MRVX^S SOM\]MR]S [XR ]MOM [XRUMOSH SOXRMWLH LZQPM\WLH LOQ6

#PL 2V\VUÛ %MOM "LO [XR M #LNLUL]VQV\L V\OLRMQOVX\ VS MNSX ]L[V\L]6 #PL RLQXUUL\]MOVX\

QX_LRS _MRVX^S SLQ^RVOT YRX_VSVX\S OPMO MRL RLNL_M\O OX M\T YMOVL\OKQNV\VQMN QMRL YRX_V]LR

V\OLRMQOVX\6

&0D %MOL -VZL] ]]6UU6&&&& ,YOVX\MN

:+0>510 KT5 )ÛLRVQ < ]]6UU6TTT 2M\]MOXRT:+0>510 %5125& (NYPM\ÛLRVQ 7 #X bL SPXROL\L] OX X\L bTOL MS

2H -H $ XR #6 "TSOLUS SPX^N]

ORM\SNMOL M\] SPX` OPL [^NN

[XRU X\ ^SLR SQRLL\S

2M\]MOXRT

:+0>510 WRR"(+0>'1 (NYPM\ÛLRVQ ;8 2M\]MOXRT

:+0>510 K22&5,, *G(5 (NYPM\ÛLRVQ < :^RRL\O13LRUM\L\O13RL_VX^S 2M\]MOXRT

:+0>510 K22&5,, Y>15 8 (NYPM\ÛLRVQ ?; 2M\]MOXRT:+0>510 K22&5,, Y>15 B (NYPM\ÛLRVQ ?; ,YOVX\MN

:+0>510

@>0G_*'X1_=>FF+T5_:'F>R5

(NYPM\ÛLRVQ ?; *,A*VSO X[ _MN^LS 2M\]MOXRT


24/79

,OPLR

U65&T51RG @'10+R0

:5&,'1 K22&5,, *G(5

(NYPM\ÛLRVQ < :^RRL\O13LRUM\L\O13RL_VX^S 2M\]MOXRT

U65&T51RG @'10+R0

:5&,'1 K22&5,, Y>15 8

(NYPM\ÛLRVQ ?; 2M\]MOXRT

U65&T51RG @'10+R0

:5&,'1 K22&5,, Y>15 8

(NYPM\ÛLRVQ ?; 2M\]MOXRT

U65&T51RG @'10+R0

:5&,'1 K22&5,, Y>15 B

(NYPM\ÛLRVQ ?; ,YOVX\MN

U65&T51RG @'10+R0:5&,'1

@>0G_*'X1_=>FF+T5_

:'F>R5 !0+0>'1


U65&T51RG @'10+R0

:5&,'1 ,0&>R0


U65&T51RG @'10+R0

:5&,'1 !0+05


U65&T51RG @'10+R0

:5&,'1 :>1 @'25

(NYPM\ÛLRVQ ?; *,A*VSO X[ _MN^LS ,YOVX\MN

U65&T51RG @'10+R0

:5&,'1 :D'15 *G(5

(NYPM\ÛLRVQ < *M\]NV\L12XbVNL133K*M\]NV\L1

)LVWPbX^R *M\]NV\L10LNMOVX\

*M\]NV\L 1)LVWPbX^R

2XbVNL10LNMOVX\ 2XbVNL

,YOVX\MN

U65&T51RG @'10+R0:5&,'1 :D'15 E"6#5& )ÛLRVQ ?8 =8


25/79

2XbVNL10LNMOVX\ 2XbVNL

@+&5 :&'S>25& :D'15

E"6#5&

)ÛLRVQ ?8 =8R

A>,0'&G

(NYPM\ÛLRVQ ?;;f *23H :TQNL %^RMOVX\H 4RM_V]MH

3MRVOT OX bL QMYO^RL] MS

SOR^QO^RL] ]MOM6 *23B ]MOLOTYLl :TQNL %^RMOVX\H 4RM_V]MH

3MRVOTB \ÛLRVQ OTYLl

,YOVX\MN

!'R>'$5R'1'6>R A>,0'&G (NYPM\ÛLRVQ ?;;f ,YOVX\MN

.66"1>c+0>'1 A>,0'&G (NYPM\ÛLRVQ

@F>1>R+F UV+6 =>0+F,

!G,0'F>R L:

)ÛLRVQ C 0+F,

+,0'F>R L:

)ÛLRVQ C


26/79

Table 8: EMR MDS

+T1',>, (NYPM\ÛLRVQ ?;;f 2M\]MOXRT

*&5+06510 :F+1

.1S5,0>T+0>'1,

(NYPM\ÛLRVQ ?;;f ,YOVX\MN

*&5+06510 :F+1

452>R+0>'1


*&5+06510 :F+1

:&'R52"&5


*&5+06510 :F+1 C5;5&&+F (NYPM\ÛLRVQ ?;;f ,YOVX\MN

W0D5& *&5+06510 :F+1

*G(5

(NYPM\ÛLRVQ 78 %VLO1*V[LKSOTNL1 ,OPLRS ,YOVX\MN

W0D5& *&5+06510 :F+1

F,

(NYPM\ÛLRVQ ?;;f 2M\]MOXRT V[

,OPLR

#RLMOUL\O

#TYL VS

SLNLQOL]

W"0R'65 (NYPM\ÛLRVQ < )L`

AVSVO1GLOOLR15XRSL1"MUL1-MOMN

2M\]MOXRT


27/79

)"Other Standards

-8?4K8?C ALRT ]V[[VQ^NO OX YRXYXSL MS OLQP\XNXWT QPM\WLS _LRT a^VQdNT

"PX^N] bL MbNL OX S^YYXRO QX\QLYOVX\KOXK]LMOP UL]VQMN RLQXR]S

"PX^N] bL MbNL OX YRLSL\O M S^UUMRT X[ NV[LKNX\W UL]VQMN RLQXR]S

"PX^N] bL MbNL OX S^YYXRO YRV_MQTH SLQRLQT M\] M^]VO ORMVN

F


28/79

*"+,-, ./0123456 .7 182#PL .OPVQMN H *LWMNH "XQVMN +SS^LS =.*"+ > W^V]LNV\LS [XR .NLQORX\VQ 2L]VQMN 0LQXR] = .20 > MRL

RLQXUUL\]L] MS [XNNX`S6

/>3 *D5 &5T"F+0>'1, 6510>'152 >1 0D>, 2'R"6510 X>FF +((FG 0' 0D5 ;'FF'X>1T 7

A5+F0DR+&5 (&'S>25&7 ( PLMNOP QMRL YRX_V]LR VS M\ V\]V_V]^MN XR M\ V\SOVO^OVX\ OPMO

YRX_V]LS YRL_L\OV_LH Q^RMOV_LH YRXUXOVX\MN XR RLPMbVNVOMOV_L PLMNOP QMRL SLR_VQLS V\ M

STSOLUMOVQ `MT OX V\]V_V]^MNSH [MUVNVLS XR QXUU^\VOVLS6 (\ V\]V_V]^MN D5+F0D R+&5

(&'S>25&UMT bL M PLMNOP QMRL YRX[LSSVX\MNH M\ MNNVL] PLMNOP YRX[LSSVX\MNH M QXUU^\VOT

PLMNOP `XRdLRH XR M\XOPLR YLRSX\ ORMV\L] M\] d\X`NL]WLMbNL V\ UL]VQV\LH \^RSV\W XRXOPLR MNNVL] PLMNOP YRX[LSSVX\SH XR Y^bNVQ1QXUU^\VOT PLMNOP6

.1,0>0"0>'1,7 #PLSL V\QN^]L PXSYVOMNSH QNV\VQSH YRVUMRT QMRL QL\ORLS M\] XOPLR SLR_VQL

]LNV_LRT YXV\OS X[ PLMNOPQMRL6

.1,"&+1R5 R'&('&+0>'1,7 ,RWM\VSMOVX\S X[[LRV\W M PLMNOP V\S^RM\QL YXNVQT6 ( PLMNOP

V\S^RM\QL YXNVQT VS M QX\ORMQO bLO`LL\ M\ V\S^RM\QL YRX_V]LR =L6W6 M\ V\S^RM\QL QXUYM\TXR M WX_LR\UL\O> M\] M\ V\]V_V]^MN XR PVS SYX\SXR =L6W6 M\ LUYNXTLR XR M QXUU^\VOT

XRWM\VcMOVX\>6

6

A5+F0DR+&5 2+0+ R'1,'F>2+0'& 7 YLRSX\S XR NLWMN L\OVOVLS `PX QXNNLQO PLMNOPQMRL RLNMOL]

]MOM [RXU _MRVX^S PLMNOPQMRL YRX_V]LRS

4'25F Y5T>,F+0>S5 Y+1T"+T58

0LSORVQOVX\S X\ /LMNOP :MRL +\[XRUMOVX\ :XNNLQOVX\/LMNOPQMRL V\[XRUMOVX\ U^SO bL


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(]]VOVX\ YRXOLQOVX\S2LOPX] OX L\S^RL OPL MQQ^RMQT H RLNVMbVNVOTH RLNL_M\QLH

QXUYNLOL\LSS M\] OVULNV\LSS X[ PLMNOPQMRL V\[XRUMOVX\ SPX^N] bL V\SOVOÔL]6

0LOL\OVX\ X[ RLNL_M\O ./0 PMS OX bL V\ ST\Q `VOP RLa^VRLUL\OS X[ LZVSOV\W +\]VM\ NM`SV\QN^]V\W +# (QO ?8886

/>>3:&'05R052 D5+F0D 2+0+ >, 25;>152 +,7

(\T V\[XRUMOVX\H `PLOPLR XRMN XR RLQXR]L] V\ M\T [XRU XR UL]VÛ OPMO VS QRLMOL] XR

RLQLV_L] bT M PLMNOP QMRL YRX_V]LRH PLMNOP V\S^RM\QL XRWM\VcMOVX\ M\] OPVR] YMROT MWL\OS

=#3(>H Y^bNVQ PLMNOP MÔPXRVOTH LUYNXTLRH NV[L V\S^RLRH SQPXXN XR ^\V_LRSVOT H 2XSO XOPLR

PLMNOP V\[XRUMOVX\ PLN] bT OPXSL `PX U^SO [XNNX` OPL NM` l M\] RLNMOLS OX OPL YMSOH

YRLSL\OH XR [Ô^RL YPTSVQMN XR UL\OMN PLMNOP XR QX\]VOVX\ X[ M\ V\]V_V]^MNl OPL YRX_VSVX\

X[ PLMNOP QMRL OX M\ V\]V_V]^MNl XR OPL YMSOH YRLSL\OH XR [Ô^RL YMTUL\O [XR OPL YRX_VSVX\

X[ PLMNOP QMRL OX M\ V\]V_V]^MN6

/>>>32510>+F>0G

M6 0LW^NMOVX\S MRL OX bL L\[XRQL] OX L\S^RL QX\[V]L\OVMNVOT X[ OPVS ]MOM M\] OPL

YMOVL\O SPX^N] PM_L M QX\ORXN X_LR OPVS6

b6 3MOVL\OS SPX^N] PM_L OPL RVWPOS OX V\SYLQO M\] MUL\] M\T V\MQQ^RMQVLS V\ OPLVR

]V N ] 0V PO O ] ] ] ] O P N] b NV VO ] O OV [


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M6 3RXOLQO M\] SLQ^RL OPL SOXRL] PLMNOP V\[XRUMOVX\

b6 5PVNL YRX_V]V\W YMOVL\O V\[XRUMOVX\H RLUX_L YMOVL\O V]L\OV[TV\W V\[XRUMOVX\H V[ VO VS

\XO \LQLSSMRT OX bL YRX_V]L]

Q6 "PX^N] L\S^RL OPMO OPLRL MRL MYYRXYRVMOL ULM\S X[ V\[XRUV\W OPL YMOVL\O X[

YXNVQVLS RLNMOV\W OX PVS1PLR RVWPOS OX PLMNOP RLQXR] YRV_MQT

]6 %XQ^UL\O MNN VOS YRV_MQT YXNVQVLS M\] L\S^RL OPMO OPLT MRL VUYNLUL\OL] M\]

[XNNX`L]6 #PVS `VNN V\QN^]LB

V6 %L_LNXY V\OLR\MN YRV_MQT YXNVQVLS

VV6 %LSVW\MOL M YRV_MQT X[[VQLR `PX `VNN bL RLSYX\SVbNL [XR VUYNLUL\OV\W

YRV_MQT YXNVQVLSH M^]VO M\] a^MNVOT MSS^RM\QL

VVV6 3RX_V]L YRV_MQT ORMV\V\W OX MNN VOS SOM[[

/S>>3 W0D5& &>TD0, '; (+0>510,

3MOVL\O SPX^N] PM_L OPL RVWPO OX MYYXV\O M YLRSX\MN RLYRLSL\OMOV_L OX QMRRT X^O OPL

MQOV_VOVLS ]LOMVNL] bLNX`6

M6 3MOVL\OS SPX^N] PM_L OPL RVWPO OX MSd [XR M QXYT X[ VOS UL]VQMN RLQXR]S PLN] bT M

PLMNOPQMRL XRWM\VcMOVX\6 #PL PLMNOPQMRL XRWM\VcMOVX\ QM\ QPMRWL M RLMSX\MbNL [LL

OX ULLO OPL M]UV\VSORMOV_L QXSOS V\_XN_L] XR YRX_V]V\W V\[XRUMOVX\ OX OPL YMOVL\O

b6 3MOVL\OS SPX^N] PM_L OPL RVWPO OX RLa^LSO M PLMNOPQMRL XRWM\VcMOVX\ `PVQP PXN]S VOS

UL]VQMN RLQXR]SH OX `VOPPXN] SYLQV[VQ V\[XRUMOVX\ OPMO PL1SPL ]XLS \XO `M\O

]VSQNXSL] OX XOPLR XRWM\VcMOVX\S XR V\]V_V]^MNS6

Q6 3MOVL\O QM\ ]LUM\] V\[XRUMOVX\ [RXU M PLMNOPQMRL YRX_V]LR X\ OPL ]LOMVNS X[]VSQNXS^RLS YLR[XRUL] X[ OPL YMOVL\OS UL]VQMN RLQXR]S6

/S>>>3 +F '; >1;'&6+0>'1


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=Z> T>0+F ,>T1+0"&5,6+G #5 ",52OX YRL_L\O \X\KRLY^]VMOVX\ bMSL] X\ OPL SYLQV[VQS X[ OPL

^SL QMSL6

0L[LRL\QL 4^V]LNV\LS [XR %VWVOMN "VW\MO^RLSH M_MVNMbNL MOhttp://egovstandards.gov.in/guidelines/Guidelines%20for%20Digital-signature/view

(]]VOVX\MN 0L[LRL\QL 4^V]LNV\LS [XR +\[XRUMOVX\ "LQ^RVOT H M_MVNMbNL MO

http://egovstandards.gov.in/guidelines/guidelines-for-information-security/view

"^b :XUUVOOLL X[ #MSd WRX^Y +++ VS YNMQL] MO (\\LZ^RL +++6
http://egovstandards.gov.in/guidelines/Guidelines%20for%20Digital-signature/viewhttp://egovstandards.gov.in/guidelines/Guidelines%20for%20Digital-signature/viewhttp://egovstandards.gov.in/guidelines/guidelines-for-information-security/viewhttp://egovstandards.gov.in/guidelines/guidelines-for-information-security/viewhttp://egovstandards.gov.in/guidelines/guidelines-for-information-security/viewhttp://egovstandards.gov.in/guidelines/Guidelines%20for%20Digital-signature/view


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9"+,-, 31:;25-R+F !5R"&>0G %">25F>15,7

/>3 UF5R0&'1>R R ,,>'17

M6 (NN ]MOM SPX^N] bL ORM\SUVOOL] ^SV\W ""*?=UV\VU^U 7?JbVO>

b6 %VWVOMN SVW\MO^RLS UMT bL ^SL] OX YRL_L\O \X\KRLY^]VMOVX\ bMSL] X\ OPL SYLQV[VQS X[ OPL

^SL QMSL6 +[ OPL .20 ]XQ^UL\OS \LL] OX bL ^YPLN] V\ M QX^RO X[ NM`H ^SL X[ ]VWVOMN

SVW\MO^RLS VS M U^SO6

/>>>3


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Q6 (WWRLWMOL ]MOM SPMRV\W [XR RLSLMRQPH LOQH SPX^N] L\S^RL OPMO YMOVL\O V]L\OVOT V\[XRUMOVX\

VS ]LKV]L\OV[VL] SX OPMO OPLRL QM\\XO bL M\T NV\d UM]L bMQd OX OPL YMOVL\O6 2LQPM\VSUS

NVdL dK M\X\TUVOT UMTbL ^SL] OX L\S^RL YMOVL\O YRV_MQT V\ OPVS QMSL6

H:I &56510,7

M6 "X[O`MRL SPX^N] PM_L M ]LSVW\ SM[LW^MR]S OX YRL_L\O MNNXQMOVX\ X[ ]MOM OX OPL `RX\W

YMOVL\O6

b6 "X[O`MRL SPX^N] L\S^RL OPMO 3MOVL\O RLQXR] VS QPM\WL] X\NT _VM M\ MUL\]UL\O YRXQLSS6

(NSXH OPL MUL\]L] Q^RRL\O _LRSVX\ SPX^N] bL UMV\OMV\L] MNX\W `VOP OPL YRL_VX^S

versions ensuring that data is not deleted.

K26>1>,0&+0>S5 %">25F>15,7

01(,9J9#$,9"- 8("#1//K


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]6 There has to be a Incident Reporting process that would be used to report incidences

X[ \X\KQXUYNVM\QL

L6 (WRLLUL\OS VOP _L\]XRS M\] XOPLR b^SV\LSS YMRO\LRS RLV\[XRQL OPL QXUUVOUL\O OXYRXOLQO OPL QX\[V]L\OVMNVOT X[ PLMNOP V\[XRUMOVX\6 ,RWM\VcMOVX\S UMT MNSX SL

QX\[V]L\OVMNVOT MWRLLUL\OS VOP SOM[[ OX RLV\[XRQL QXUUVOUL\O OX UMV\OMV\V\W OPL

QX\[V]L\OVMNVOT X[ PLMNOP V\[XRUMOVX\6

:DG,>R+F !5R"&>0G %">25F>15,7

M6 #PLRL PMS OX bL M YRXQLSS OX QX\ORXN MQQLSS OX SLR_LRS QX\OMV\V\W .20 ]MOM6 3RXQLSS PMS

OX L\S^RL OPMO X\NT OPL MbSXNÔL \LQLSSMRT SOM[[ PMS MQQLSS OX OPVSb6 3MYLR 1 )X\KLNLQORX\VQ ]MOM PMS OX bL SLQ^RL] ^SV\W RLMSX\MbNL ULM\S6 "^QP

V\[XRUMOVX\ PMS OX bL V\ OPL QX\ORXN X[ OPL YLXYNL `PX MRL MÔPXRVcL] OX MQQLSS VO6

Q6 :XYVLSH [MZLSH YRV\OXÔSH XR M\T UL]VÛ QX\OMV\V\W

V6 PLMNOP V\[XRUMOVX\ SPX^N] bL ]LSORXTL] M[OLR ^SL XR RLOMV\L] V\

VV6 M SLQ^RL NXQMOVX\6 #RM\SUVOOL] UMOLRVMN SPX^N] bL MQQXUYM\VL]

VVV6 bT M SOMOLUL\O X[ QX\[V]L\OVMNVOT M\] RLSYX\SVbVNVOT6 #PL RLQLV_V\W

V_6 YMROT VS OPL\ RLSYX\SVbNL [XR OPL SLQ^RVOT M\] QX\[V]L\OVMNVOT

_6 X[ OPL ORM\SUVOOL]1QXYVL] PLMNOP V\[XRUMOVX\6


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8`9 REFERENCES=7> -V\MN 0LQXUUL\]MOVX\H -RMUL`XRd [XR +\[XRUMOVX\ #LQP\XNXWT +\[RMSOR^QO^RL [XR

/LMNOP V\ +\]VM =+#+/+>H AXN^ULS + ' ++H %+#H 2:+#H 4X_O6 X[ +\]VM=?> 0LQXUUL\]MOVX\S X\ 4^V]LNV\LSH "OM\]MR]S ' 3RMQOVQLS [XR #LNLUL]VQV\L V\ +\]VMH %+#H

2:+#H 4X_O6 X[ +\]VM

=C> /+2 3RV\QVYNLS V\ /LMNOP +\[XRUMOVX\ .ZQPM\WL =3RMQOVQL GRVL[>

=9> ?88F /+2"" 0/+, %L[V\VOVX\ 5XRdWRX^Y

=;> POOYB11PLMNOPVO6PPS6WX_1YXROMN1SLR_LR6YOqXYL\r;7?'Xbh+%r? %LYMROUL\O X[ /LMNOP M\] /^UM\ "LR_VQLSH $"(H $"( GVNNV\W :X]LB 97;8K9;

= /+3(( *M`SB 3RV_MQT M\] "LQ^RVOT 9; :-0 79?

=78> ./0 2LM\V\W[^N $SL=77> ::0POOYB11```6MSOU6XRW1"OM\]MR]S1.?CF


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!!" Annexures

$77CM3?C .GO related to Sub-Groups Formation

"#$#%&'( )* +,-.&/ -$0 1-2#.( 3,.*-',

4,5-'&2,$& )* +,-.&/ -$0 1-2#.( 3,.*-',6#'2-$ 7/-8-$9 6,8 4,./#:;; : ?&-$0-'0#D-)$ )* E.,C&')$#C ",0#C-. F,C)'0%G

123 45637/89536 8/ 6873:;36 ;. 7335 85 ;23

'/;?33;859 .< @AB C;=56=76/ D.??8;;33 6=;36 E&;2C30;#F $&'& 739=76859

:.5/;8;4;8.5 .< C4G,H7.40/ 859 40 I=78.4/ ;=/>/


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=/03:;/):.?0J=85;/F

94863J853/ =56

730.7;/ =J73=6N=I=8J=GJ3#

776 P7# [=I335 T=85F DPSD

7?6 P7# S745 X=J

7C6 A7# A=624 S7=I856

Contd2/,

,$,

123 H7.40 -3=6/ =56 ;23 ?3?G37/ .< ;23 /4G 97.40/ =73

73\43/;36 ;. :.?0J3;3 ;23 ;=/>/ =//89536 ;. ;23? L8;285 ;23 /;804J=;36;8?3 SJJ 5.5,.


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Annexure II

Sub- Committee of Task Group III

!F9

E'9

E+65,

76 Prof. Saroj K. MishraSanjay Gandhi PG Inst. of Medical Sciences

?6 Prof. Indrajit BhattacharyaIIHMR , New Delhi

C6 Mr. Madhu Aravind,HealthHiway

96 Dr.Karanvir Singh, Head -Medical InformaticsGangaram Hospital

;6 Pawan Duggal , Supreme Court Advocate

F6 Dr. Sunil Jain ,Medico- Legal ExpertGangaram Hospital

@6 Dr.Nalin Mehta, Bio- ethics Expert,AIIMS

J6 Dr.Kusum Verma, CytopathologistGangaram Hospital


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ANNEXURE III

Preparatory Process for Draft Recommendations

Committee Discussions 3XSO [XRUMOVX\ V\VOVMOVX\

:XUU^\VQMOVX\ _VM LUMVNH OLNLQX\[LRL\QLS

3PTSVQMN ULLOV\WS `PLRL L_LR YXSSVbNL

! #"+ :X\WRLSS MO GP^bM\LSP`MRH ,]VSPM

! +\]XK"`L]VSP 5XRdSPXY MO 3^\LH 2MPMRMSPORM

! +\[XRUMN ]VSQ^SSVX\ MUX\WSO S^bKWRX^Y ULUbLRS

! +\[XRUMN ULLOV\WS bLO`LL\ VUYXROM\O1\XUV\MOL] ULUbLRS M\] :PMVRUM\H S^bK

WRX^YS


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ANNEXURE IV

%F',,+&G '; 452>R+F *5&6,

n ( o

KRR5,,: The patients ability to obtain medical care. The ease of access is determined by such

QXUYX\L\OS MS OPL M_MVNMbVNVOT X[ UL]VQMN SLR_VQLS M\] OPLVR MQQLYOMbVNVOT OX OPL YMOVL\OH OPL NXQMOVX\ X[

PLMNOP QMRL [MQVNVOVLSH ORM\SYXROMOVX\H PX^RS X[ XYLRMOVX\ M\] QXSO X[ QMRL6 (QQLSS ]LSQRVbLS M\

individuals ability to obtain appropriate health care services. Barriers to access ca\ bL [V\M\QVMN

=V\S^[[VQVL\O UX\LOMRT RLSX^RQLS>H WLXWRMYPVQ =]VSOM\QL OX YRX_V]LRS>H XRWM\VcMOVX\MN =NMQd X[ M_MVNMbNL

YRX_V]LRS> M\] SXQVXNXWVQMN =L6W6H ]VSQRVUV\MOVX\H NM\W^MWL bMRRVLRS>6 .[[XROS OX VUYRX_L MQQLSS X[OL\ [XQ^S

X\ YRX_V]V\W1VUYRX_V\W PLMNOP QX_LRMWL6

KR0>S5FG$+0$a'&-: Describes insurers policy requirement indicating that coverage will not go into effect

until the employees first day of work on or after the effective date of coverage. May also apply to

]LYL\]L\OS ]VSMbNL] X\ OPL L[[LQOV_L ]MOL6

KR0>S>0>5, '; FG Y>S>1T: (ADLs, ADL) K An individuals daily habits such as bathing, dressing and eating.

ADLs are often used as an assessment tool to determine an individuals ability to function at home, or inM NLSS RLSORVQOL] L\_VRX\UL\O X[ QMRL6

K22512"6B #LZO OPMO VS M]]L] OX M ]XQ^UL\O M[OLR VO PMS bLL\ [V\MNVcL]6

K2O"2>R+0>'1B 3RXQLSSV\W QNMVUS MQQXR]V\W OX QX\ORMQO6

KR T>0+F !"#,R&>#5& Y>1537 ( OTYL X[ %"* OPMO ^SLS QXYYLR OLNLYPX\L NV\LS OX ORM\SUVO

]MOM [MSOLR OPM\ M ORM]VOVX\MN UX]LU6 (%"* X\NT `XRdS `VOPV\ SPXRO ]VSOM\QLS bLQM^SL VO ^SLS PVWP[RLa^L\QVLS VOP SPXRO SVW\MNS6

KF5&0,B 3XYK^YS XR RLUV\]LRS (\ M^OXUMOL] `MR\V\W STSOLU S^QP M QNV\VQMN MNLROS YRL_L\OV_L PLMNOP


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YRXWRMU V\ a^LSOVX\ M\] MRL \XO RLVUb^RSL]6 #PL UXSO QXUUX\ [XRU X[ QXSO RLVUb^RSLUL\O VS OPL

cost report methodology used for DRGKLZLUYO SLR_VQLSH S^QP MS UM\T XÔKYMOVL\O PXSYVOMN bMSL]

YRXWRMUSH NX\WKOLRU QMRL M\] SdVNNL] \^RSV\W ^\VOSH YPTSVQMN RLPMbH YSTQPVMORVQ M\] S^bSOM\QL Mb^SL

V\YMOVL\O YRXWRMUS6 "XUL SYLQVMNOT PXSYVOMNS RLQLV_L MNN X[ OPLVR :2" RLVUb^RSLUL\O MS QXSO bMSL]

RLVUb^RSLUL\O6

K6#"F+0'&G R+&57 (\T UL]VQMN QMRL ]LNV_LRL] X\ M\ XÔYMOVL\O bMSVS6

K11'0+0'&B ( STSOLU [^\QOVX\ OPMO MNNX`S M\ LZYNM\MOXRT \XOL XR ]VMWRMU OX bL M]]L] OX M\ VUMWL6

K(('>106510!RD52"F5&B #PL MYYXV\OUL\O SQPL]^NLR `PVQP OMdLS QPMRWL X[ TX^R MYYXV\OUL\O ORMQdV\WH

[VZV\W M\] bNXQdV\W6

K!:B (YYNVQMOVX\ "LR_VQL 3RX_V]LR =M6d6M6 K 5Lb bMSL]>

K!: /K((F>R+0>'1, !5&S>R5 :&'S>25&37 (YYNVQMOVX\ SLR_VQL YRX_V]LR VS M b^SV\LSS OPMO YRX_V]LS QXUYÔLR

bMSL] SLR_VQLS OX Q^SOXULRS X_LR M \LO`XRd6 $S^MNNT `Lb bMSL]H `VOPV\ OPL ./01.20 SXNÔVX\ YMRM]VWU

VO VS M RLUXOLNT PXSOL] YRXWRMU M\] ]MOMbMSL6 (]_M\OMWLS MRL RL]^QL] V\VOVMN V\_LSOUL\O V\ PMR]`MRL

M\] RL]^QL] RLSYX\SVbVNVOT V\ UMV\OL\M\QL X[ SLR_LR M\] ]MOM6 #PL ]VSM]_M\OMWLS MRL QXUYNLOLNT

]LYL\]L\O X\ V\OLR\LO QX\\LQOV_VOT M\] X\ OPL SLR_LR PXSO SYLL] OX MQQLSS VUMWLSH SQM\\L] ]XQÛL\OSHLOQ6 *X\W OLRU QXSO VS [RLa^L\ONT WRLMOLR6

K!: /KR0>S5 !5&S5& :+T537 VS ]T\MUVQMNNT WL\LRMOL] `Lb YMWL `VOP OPL ^SL X[ (QOV_LE SQRVYOV\WH `PVQP

LZLQÔLS X\ OPL SLR_LR V\SOLM] X\ OPL 5Lb bRX`SLR =/#2*>6 #PL "LR_LR LZLQÔLS OPL [VNL M\] WL\LRMOLS

M\ /#2* [XRUMOOL] YMWL [XR "LMRQP .\WV\L "YV]LRS XR 5Lb GRX`SLRS SX VO QM\ bL ]VSYNMTL] YRXYLRNT6

K"0D510>R+0>'1B #PL _LRV[VQMOVX\ X[ OPL V]L\OVOT X[ M YLRSX\ XR YRXQLSS6

K"0D'&>c+0>'1B (\T ]XQÛL\O ]LSVW\MOV\W M\T YLRUVSSVX\6 #PL/+3((3RV_MQT 0^NL RLa^VRLS

MÔPXRVcMOVX\ XR MV_LR X[ MÔPXRVcMOVX\ [XR OPL SL XR ]VSQNXS^RL X[ V]L\OV[VMbNL PLMNOP V\[XRUMOVX\ [XR

RLSLMRQP =MUX\W XOPLR MQOV_VOVLS>6 #PL MÔPXRVcMOVX\ U^SO V\]VQMOL V[ OPL PLMNOP V\[XRUMOVX\ ^SL] XR
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L+F+1R5P'&X+&2B (\ MQQX^\OV\W RL[LRL\QL [XR OPL MUX^\O XÔSOM\]V\W X\ M\ MQQX^\O ORM\S[LRRL] [RXU

M\XOPLR bVNNV\W STSOLU6 3RVUMRVNT SL] ]^RV\W ]MOM UVWRMOVX\ [RXU TX^R NLWMQT STSOLU OX TX^R \L`

2L]V\[XRUMOVZ STSOLU

L52'&+FA5+F0DH L5D+S>'&+FA5+F0DR+&5B (\ ÛbRLNNM OLRU OPMO V\QN^]LS UL\OMN PLMNOPH YSTQPVMORVQH

UMRRVMWL M\] [MUVNT QX^\SLNV\WH M]]VQOVX\S ORLMOUL\O M\] S^bSOM\QL Mb^SL6 "LR_VQLS MRL YRX_V]L] bT M

UTRVM] X[ YRX_V]LRSH V\QN^]V\W SXQVMN XRdLRSH QX^\SLNXRSH YSTQPVMORVSOH YSTQPXNXWVSOSH \L^RXNXWVSOS M\]

even family practice physicians. Many states have parity laws that attempt to require that beha_VXRMN

health insurance coverage be provided on par to physical health coverage.

L515;>R>+&G=KF,'5F>T>#F5l 51&'FF55l 656#5&>B +\]V_V]^MN `PX VS LVOPLR ^SV\W XR LNVWVbNL OX ^SL V\S^RM\QL

bL\L[VOSH V\QN^]V\W PLMNOP V\S^RM\QL bL\L[VOSH ^\]LR M\ V\S^RM\QL QX\ORMQO6 +O ]LSQRVbLS M\T YLRSX\

LNVWVbNL MS LVOPLR M S^bSQRVbLR XR M ]LYL\]L\O [XR M UM\MWL] QMRL SLR_VQL V\ MQQXR]M\QL `VOP M QX\ORMQO6

(\ V\]V_V]^MN PX RLQLV_LS bL\L[VOS [RXU XR VS QX_LRL] bT M\ V\S^RM\QL YXNVQT XR XOPLR PLMNOP QMRL

[V\M\QV\W YRXWRMU6

GVNNL] :NMVUSB -LLS S^bUVOOL] bT M PLMNOP QMRL YRX_V]LR [XR SLR_VQLS RL\]LRL] OX M QX_LRL] YLRSX\6 -LLSbVNNL] M\] [LLS YMV] MRL RMRLNT ST\X\TUX^S6

L4.=L'2G4+,,.125V>B :MNQ^NMOVX\ bMSL] X\ PLVWPO M\] `LVWPO6 #PVS VS SVUVNMR OX YLRQL\O bX]T [MO M\]

demonstrates how much effect a persons weight is on their health.

L4. RD+&0,7 G2+ QPMROS VOPV\ .20 STSOLUS QM\ UM\VY^NMOL ]MOMH YLR[XRU QMNQ^NMOVX\SH M\] M]MYO OX

^SLR YRL[LRL\QLS M\] YMOVL\O QPMRMQOLRVSOVQSH ^SLRS UMT LZYLQO WRLMOLR [^\QOVX\MNVOT [RXU LNLQORX\VQ G2+

QPMROS6

L!K =L'2G!"&;+R5K&5+>B +\ YPTSVXNXWT M\] UL]VQV\LH OPL bX]T S^R[MQL MRLM =G"(> VS OPL ULMS^RL] XR

QMNQ^NMOL] S^R[MQL X[ M PÛM\ bX]T -XR UM\T QNV\VQMN Y^RYXSLS G"( VS M bLOOLR V\]VQMOXR X[ ULOMbXNVQ


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@+(>0+052 (+G6510,7 3MTUL\O [XR PLMNOPQMRL SLR_VQLS bMSL] X\ OPL \ÛbLR X[ YMOVL\OS PX MRL QX_LRL]

[XR SYLQV[VQ SLR_VQLS X_LR M SYLQV[VL] YLRVX] X[ OVUL RMOPLR OPM\ OPL QXSO XR \ÛbLR X[ SLR_VQLS OPMO MRL

MQO^MNNT YRX_V]L]6

@+,54+1+T5&B ( \^RSLH ]XQOXRH XR SXQVMN `XRdLR `PX `XRdS `VOP YMOVL\OSH YRX_V]LRS M\] V\S^RLRS OX

QXXR]V\MOL MNN SLR_VQLS ]LLUL] \LQLSSMRT OX YRX_V]L OPL YMOVL\O VOP M YNM\ X[ UL]VQMNNT \LQLSSMRT M\]

MYYRXYRVMOL PLMNOP QMRL6

@+,54+1+T56510B 2LOPX] ]LSVW\L] OX MQQXUUX]MOL OPL SYLQV[VQ PLMNOP SLR_VQLS \LL]L] bT M\

V\]V_V]^MN OPRX^WP M QXXR]V\MOL] L[[XRO OX MQPVL_L OPL ]LSVRL] PLMNOP XÔQXUL V\ M QXSO L[[LQOV_L

UM\\LR6 #PL UX\VOXRV\W M\] QXXR]V\MOVX\ X[ ORLMOUL\O RL\]LRL] OX YMOVL\OS `VOP SYLQV[VQ ]VMW\XSVS XR

RLa^VRV\W PVWPKQXSO XR LZOL\SV_L SLR_VQLS6 :MSL UM\MWLUL\O VS OPL YRXQLSS bT `PVQP MNN PLMNOPKRLNMOL]UMOOLRS X[ M QMSL MRL UM\MWL] bT M YPTSVQVM\ XR \^RSL XR ]LSVW\MOL] PLMNOP YRX[LSSVX\MN6 3PTSVQVM\ QMSL

UM\MWLRS QXXR]V\MOL ]LSVW\MOL] QXUYX\L\OS X[ PLMNOP QMRLH S^QP MS MYYRXYRVMOL RL[LRRMN OX QX\S^NOM\OSH

SYLQVMNVSOSH PXSYVOMNSH M\QVNNMRT YRX_V]LRS M\] SLR_VQLS6 :MSL UM\MWLUL\O VS V\OL\]L] OX L\S^RL

QX\OV\^VOT X[ SLR_VQLS M\] MQQLSSVbVNVOT OX X_LRQXUL RVWV]VOTH [RMWUL\OL] SLR_VQLSH M\] OPL UVSSK

ÔVNVcMOVX\ X[ [MQVNVOVLS M\] RLSX^RQLS6 +O MNSX MOOLUYOS OX UMOQP OPL MYYRXYRVMOL V\OL\SVOT X[ SLR_VQLS VOP

the patients needs over timL6

@+,5!5S5&>0GB ( ULMS^RL X[ V\OL\SVOT XR WRM_VOT X[ M WV_L\ QX\]VOVX\ XR ]VMW\XSVS [XR M YMOVL\O6 2MT PM_L]VRLQO QXRRLNMOVX\ `VOP OPL MUX^\O X[ SLR_VQL YRX_V]L] M\] OPL MSSXQVMOL] QXSOS XR YMTUL\OS MNNX`L]6

@@A.*B (QRX\TU [XR :LROV[VQMOVX\ :XUUVSSVX\ [XR /LMNOPQMRL +\[XRUMOVX\ #LQP\XNXWT VS OPL RLQXW\VcL]

QLROV[VQMOVX\ MÔPXRVOT [XR LNLQORX\VQ PLMNOP RLQXR]S M\] OPLVR \LO`XRdSH M\] M\ V\]LYL\]L\OH _XN^\OMRTH

YRV_MOLKSLQOXR V\VOVMOV_L6

@D+>1';*&",0KT&556510B 0L[LRRL] OX V\/+3((R^NLSH OPVS VS M QX\ORMQO \LL]L] OX LZOL\] OPL

RLSYX\SVbVNVOT OX YRXOLQO PLMNOP QMRL ]MOM MQRXSS M SLRVLS X[ S^bKQX\ORMQO^MN RLNMOVX\SPVYS6

@AK4:\!B :V_VNVM\ /LMNOP M\] 2L]VQMN 3RXWRMU X[ OPL $\V[XRUL] "LR_VQLS6


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@F>510$!5&S5&7 ( \LO`XRd MRQPVOLQO^RL `PVQP SLYMRMOLS OPL QNVL\O =X[OL\ M\ MYYNVQMOVX\ OPMO ^SLS M

WRMYPVQMN ^SLR V\OLR[MQL> [RXU OPL SLR_LR6

@'6("05&>c52 :+0>510 C5R'&2 /@:C37 (NSX d\X`\ MS M\ .20 XR ./06 ( YMOVL\OmS YMSOH YRLSL\OH M\] [Ô^RL

QNV\VQMN ]MOM SOXRL] V\ M SLR_LR6

@'6("05&>c52 :DG,>R>+1 W&25& U10&G /@:WU37( STSOLU [XR YPTSVQVM\S OX LNLQORX\VQMNNT XR]LR NMbSH

VUMWV\W M\] YRLSQRVYOVX\S

@:* @'257( \MOVX\MNNT RLQXW\VcMbNL [V_LK]VWVO \ÛbLR ^SL] OX RLYRLSL\O M SLR_VQL YRX_V]L] bT M

PLMNOPQMRL YRX_V]LR6

@F>5101!5&S5&+&RD>05R0"&5B (\ V\[XRUMOVX\KORM\SUVSSVX\ MRRM\WLUL\OH V\ `PVQP M QNVL\O YRXWRMU SL\]S M

RLa^LSO OX M SLR_LR6 5PL\ OPL SLR_LR RLQLV_LS OPL RLa^LSOH VO ]VSQX\\LQOS [RXU OPL QNVL\O M\] YRXQLSSLS

OPL RLa^LSO6 5PL\ OPL RLa^LSO VS YRXQLSSL]H OPL SLR_LR RLQX\\LQOS OX OPL QNVL\O YRXWRMU M\] OPL

V\[XRUMOVX\ VS ORM\S[LRRL] OX OPL QNVL\O6 #PVS S^MNNT VUYNVLS OPMO OPL SLR_LR VS NXQMOL] X\ SVOL MS XYYXSL]

OX OPL ("3 =(YYNVQMOVX\ "LR_LR 3RX_V]LR> MRQPVOLQO^RL6

@F>1>R+F1>R+F,>'1,"(('&0,G,056=@B ( QNV\VQMN ]LQVSVX\ S^YYXRO STSOLU =:%""> VS SX[O`MRL ]LSVW\L]

OX MV] QNV\VQVM\S V\ ]LQVSVX\ UMdV\W bT UMOQPV\W V\]V_V]^MN YMOVL\O QPMRMQOLRVSOVQS OX QXUYÔLRVcL]

d\X`NL]WL bMSLS [XR OPL Y^RYXSL X[ WL\LRMOV\W YMOVL\OKSYLQV[VQ MSSLSSUL\OS XR RLQXUUL\]MOVX\S6

@F>1>R+F%">25F>15,=:&'0'R'F,>B :NV\VQMN W^V]LNV\LS MRL RLQXUUL\]MOVX\S bMSL] X\ OPL NMOLSO M_MVNMbNLL_V]L\QL [XR OPL MYYRXYRVMOL ORLMOUent and care of a patients condition.

@F>1>R+F 65,,+T>1TB :XUU^\VQMOVX\ X[ QNV\VQMN V\[XRUMOVX\ `VOPV\ OPL LNLQORX\VQ UL]VQMN RLQXR] OX XOPLR


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@WLCKB "LL :X\SXNV]MOL] ,U\Vb^S G^]WLO 0LQX\QVNVMOVX\ (QO6

@'2521T: A mechanism for identifying and defining physicians and hospitals services. Coding provides

^\V_LRSMN ]L[V\VOVX\ M\] RLQXW\VOVX\ X[ ]VMW\XSLSH YRXQL]^RLS M\] NL_LN X[ QMRL6 :X]LRS ^S^MNNT XRd V\UL]VQMN RLQXR]S ]LYMROUL\OS M\] QX]V\W VS M [^\QOVX\ X[ bVNNV\W6 2L]VQMRL [RM^] V\_LSOVWMOXRS NXXd

QNXSLNT MO OPL UL]VQMN RLQXR] ]XQÛL\OMOVX\H PVQP S^YYXROS QX]LS M\] NXXdS [XR QX\SVSOL\QT6 *MQd X[

consistency of documentation can earmark a record as upKcoded which is considered fraud. A national

QLROV[VQMOVX\ LZVSOS [XR QX]V\W YRX[LSSVX\MNS M\] UM\T QXUYNVM\QL YRXWRMUS MRL RMVSV\W SOM\]MR]S X[

a^MNVOT [XR OPLVR QX]V\W YRXQL]^RLS6

@'$.1,"&+1R5 /R'>1,"&+1R537( QXSOKSPMRV\W RLa^VRLUL\O ^\]LR M PLMNOP V\S^RM\QL YXNVQT OPMO YRX_V]LS

OPMO OPL V\S^RL] `VNN MSSÛL M YXROVX\ XR YLRQL\OMWL X[ OPL QXSOS X[ QX_LRL] SLR_VQLS6 /LMNOP QMRL QXSO`PVQP OPL QX_LRL] YLRSX\ VS RLSYX\SVbNL [XR YMTV\WH MQQXR]V\W OX M [VZL] YLRQL\OMWL XR MUX^\O6 ( YXNVQT

YRX_VSVX\ [RLa^L\ONT [X^\] V\ UMhXR UL]VQMN V\S^RM\QL YXNVQVLS \]LR PVQP OPL V\S^RL] V\]V_V]^MN M\]

OPL V\S^RLR SPMRL PXSYVOMN M\] UL]VQMN LZYL\SLS MQQXR]V\W OX M SYLQV[VL] RMOVX6 ( OTYL X[ QXSO SPMRV\W

`PLRL OPL V\S^RL] YMROT M\] V\S^RLR SPMRL YMTUL\O X[ OPL MYYRX_L] QPMRWL [XR QX_LRL] SLR_VQLS V\ M

SYLQV[VL] RMOVX M[OLR YMTUL\O X[ OPL ]L]^QOVbNL6 $\]LR 2L]VQMRL 3MRO GH OPL bL\L[VQVMRT YMTS QXV\S^RM\QL

X[ ?8 YLRQL\O X[ MNNX`L] QPMRWLS6 2M\T /2,S YRX_V]L 788i V\S^RM\QL =\X QXV\S^RM\QL> [XR YRL_L\OV_L

care or routing care provided in network.

@'66'1 C"F5B $\]LR/+3((HVO XÔNV\LS OPL \LQLSSVOT X[ XbOMV\V\W V\[XRUL] QX\SL\O [RXU YMOVL\OS6

@'6("05&$L+,52 :+0>510 C5R'&2 /@:C37 ( OLRU [XR OPL YRXQLSS X[ RLYNMQV\W OPL ORM]VOVX\MN YMYLR bMSL]
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@',0 !D+&>1TB 3MTUL\O ULOPX] `PLRL M YLRSX\ VS RLa^VRL] OX YMT SXUL PLMNOP QXSOS V\ XR]LR OX RLQLV_L

UL]VQMN QMRL6 #PL WL\LRMN SLO X[ [V\M\QV\W MRRM\WLUL\OS PLRLbT OPL QX\SÛLR U^SO YMT XÔKX[KYXQdLO

OX RLQLV_L QMRLH LVOPLR MO OPL OVUL X[ V\VOVMOV\W QMRLH XR ]^RV\W OPL YRX_VSVX\ X[ PLMNOP QMRL SLR_VQLSH XR

bXOP6 #PVS V\QN^]LS ]L]^QOVbNLSH QXV\S^RM\QL M\] QXKYMTUL\OSH bÔ \XO OPL SPMRL X[ OPL YRLUVÛ YMV] bT

OPL YLRSX\ L\RXNNL]6

@"&&510 :&'R52"&+F *5&6>1'F'TG /@:*37( SOM\]MR]VcL] ULQPM\VSU X[ RLYXROV\W SLR_VQLS ^SV\W \ÛLRVQ

QX]LS MS LSOMbNVSPL] M\] ^Y]MOL] M\\^MNNT bT OPL (2(6 +O VS M UM\^MN OPMO MSSVW\S [V_L ]VWVO QX]LS OX

UL]VQMN SLR_VQLS M\] YRXQL]^RLS OX SOM\]MR]VcL QNMVUS YRXQLSSV\W M\] ]MOM M\MNTSVS6 #PL QX]V\W STSOLU

[or physicians services developed by the CPT Editorial Panel of the American Medical Association; basis

X[ OPL 2L]VQMRL QX]V\W STSOLU [XR YPTSVQVM\S SLR_VQLS6 ( UL]VQMN QX]L SLO X[ YPTSVQVM\ M\] XOPLR

SLR_VQLSH UMV\OMV\L] M\] QXYTRVWPOL] bT OPL (ULRVQM\ 2L]VQMN (SSXQVMOVX\ =(2(>H M\] M]XYOL] bT OPL

"LQRLOMRT X[ //" MS OPL SOM\]MR] [XR RLYXROV\W YPTSVQVM\ M\] XOPLR SLR_VQLS X\ SOM\]MR] ORM\SMQOVX\S6

"LL :X]V\W6

@",0'6+&G? (&5S+>F>1T? +12 &5+,'1+#F5 /@:C37:^RRL\O ULOPX] X[ YMTV\W YPTSVQVM\S ^\]LR 2L]VQMRL6

Payment for a service is limited to the lowest of (1) the physicians billed charge for the service, (2) the

physicians customary charge for the service, or (3) the prevailing charge for that service in the

QXUU^\VOT6 "VUVNMR OX OPL $S^MNH :^SOXUMRTH M\] 0LMSX\MbNL STSOLU ^SL] bT YRV_MOL V\S^RLRS6

n % o


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YRX_V]LRS X[ MNN OTYLSH YMTLRSH LUYNXTLRS PX MRL ]L_LNXYV\W OPLVR X`\ V\KPX^SL SLR_VQL STSOLUSH OPL

]R^W QXUYM\VLS6


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UF5R0&'1>R 452>R+F C5R'&2, /U4C37( QXUYÔLRKbMSL] RLQXR] QX\OMV\V\W PLMNOP QMRL V\[XRUMOVX\6 #PVS

OLQP\XNXWTH `PL\.20[^NNT ]L_LNXYL]H ULLOS YRX_V]LR \LL]S [XR RLMNKOVUL ]MOM MQQLSS M\] L_MN^MOVX\

V\ UL]VQMN QMRL6 #XWLOPLR `VOP QNV\VQMN `XRdSOMOVX\S M\] QNV\VQMN ]MOM RLYXSVOXRT OLQP\XNXWVLSH OPL

YRX_V]LS OPL ULQPM\VSU [XR NX\WVO^]V\MN ]MOM SOXRMWL M\] MQQLSS6 ( UXOV_MOVX\ [XR PLMNOPQMRL L\OVOVLS OX

VUYNLUL\O OPVS OLQP\XNXWT ]LRV_LS [RXU OPL \LL] [XR UL]VQMN XÔQXUL SO^]VLSH UXRL L[[VQVL\O QMRLH

SYLL]VLR QXUU^\VQMOVX\ MUX\W YRX_V]LRS M\] UM\MWLUL\O X[ PLMNOP YNM\S6 #PVS RLQXR] UMT QX\OMV\

some, but not necessarily all, of the information that is in an individuals paperKbMSL] UL]VQMN RLQXR]6

,\L WXMN X[/+3((VS OX YRXOLQO V]L\OV[VMbNL PLMNOP V\[XRUMOVX\ MS OPL STSOLU UX_LS [RXU M YMYLRKbMSL]

OX M\ LNLQORX\VQ UL]VQMN RLQXR] STSOLU6 "LL MNSX :XUYÔLRVcL] 2L]VQMN 0LQXR]6

U4C7(QRX\TU [XR .NLQORX\VQ 2L]VQMN 0LQXR]S6 ( QXUYÔLRVcL] RLQXR] X[ M YMOVL\OmS QNV\VQMNH

]LUXWRMYPVQ M\] M]UV\VSORMOV_L ]MOM6 (NSX d\X`\ MS M QXUYÔLRKbMSL] YMOVL\O RLQXR] =:30> XRLNLQORX\VQ PLMNOP RLQXR] =./0>6

UF5R0&'1>R UF>T>#>F>0G7OPVS .20 [LMO^RL MQQLSS M YMTLR OX ]LNV_LR ^YKOXK]MOL V\S^RM\QL bL\L[VOS LNVWVbVNVOT

V\[XRUMOVX\ X\ YMOVL\OS6

UF5R0&'1>R A5+F0D C5R'&2, /UAC37 3MOVL\O PLMNOP RLQXR]S V\QN^]V\W ORLMOUL\O PVSOXRTH UL]VQMN OLSO

RLYXROSH M\] VUMWLS SOXRL] V\ M\ LNLQORX\VQ [XRUMO OPMO QM\ bL MQQLSSL] bT PLMNOPQMRL YRX_V]LRS X\ M

QXUYÔLR \LO`XRd

U:CB GRXM]NT ]L[V\L]H M YLRSX\MN PLMNOP RLQXR] VS OPL ]XQÛL\OMOVX\ X[ M\T [XRU X[ YMOVL\O

V\[XRUMOVX\V\QN^]V\W UL]VQMN PVSOXRTH UL]VQV\LSH MNNLRWVLSH _VSVO PVSOXRTH XR _MQQV\MOVX\SOPMO YMOVL\OS

OPLUSLN_LS UMT _VL`H QMRRTH MUL\]H M\\XOMOLH XR UMV\OMV\6 #X]MTH `PL\ `L RL[LR OX 3/0SH `L OTYVQMNNT

ULM\ M\ X\NV\L YLRSX\MN PLMNOP RLQXR]`PVQP UMT _MRVX^SNT bL RL[LRRL] OX MS M\ L3/0H M\ +\OLR\LO 3/0H

M\ +\OLR\LO UL]VQMN RLQXR]H XR M QX\SÛLR +\OLR\LO 2L]VQMN 0LQXR] =:+20>6 4L\LRMNNTH S^QP RLQXR]S MRL

UMV\OMV\L] V\ M SLQ^RL M\] QX\[V]L\OVMN L\_VRX\UL\OH MNNX`V\W X\NT OPL V\]V_V]^MNH XR YLXYNL MÔPXRVcL]

bT OPL V\]V_V]^MNH OX MQQLSS OPL UL]VQMN V\[XRUMOVX\6 )XO MNN LNLQORX\VQ 3/0S MRL +\OLR\LO 3/0S6 3:KbMSL]3/0S UMT bL SLO ^Y OX QMYO^RL UL]VQMN V\[XRUMOVX\ X[[NV\L6

F > #>FF N [ ] [ ] ] b NN
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P55 !RD52"F5,B ( SLO UMZVU^U [LL OPMO M\ V\S^RM\QL QXUYM\T `VNN YMT M PLMNOPQMRL YRX_V]LRH VO VS M NVSO

X[ MNN :3# M\] /:3:" QX]LS M\] OPLVR QXRRLSYX\]V\W QPMRWLS6 #PVS QM\ bL _MRVMbNL bMSL] X\ V\S^RM\QL6

-LL SQPL]^NLS MRL ^S^MNNT MSSXQVMOL] `VOP M YMROVQ^NMR YMTLR M\] RL[NLQO OPL RLVUb^RSLUL\O RMOLS

\LWXOVMOL] ^\]LR OPL QX\ORMQO6

P55$;'&$,5&S>R57( PLMNOP V\S^RM\QL YNM\ OPMO MNNX`S YXNVQTPXN]LRS OX YMT [XR M\T YRX_V]LR SLR_VQLH S^bUVO

M QNMVU OX OPL V\S^RM\QL QXUYM\TH M\] WLO RLVUb^RSL] V[ OPL SLR_VQL VS QX_LRL] bT OPL V\S^RM\QL

YRX_V]LR

P>&,0


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n / o

A5+F0D +12 A"6+1 !5&S>R5, /AA!37#PL %LYMROUL\O X[ /LMNOP M\] /^UM\ "LR_VQLS OPMO VS RLSYX\SVbNL

[XR PLMNOPKRLNMOL] YRXWRMUS M\] VSS^LS6 -XRULRNT VO `MS d\X`\ MS /.5H OPL %LYMROUL\O X[ /LMNOPH.]^QMOVX\H M\] 5LN[MRL6 #PL ,[[VQL X[ /LMNOP 2MV\OL\M\QL ,RWM\VcMOVX\S =,/2,> VS YMRO X[ //" M\]

]LOMVNL] V\[XRUMOVX\ X\ UXSO QXUYM\VLS VS M_MVNMbNL PLRL OPRX^WP OPL -RLL]XU X[ +\[XRUMOVX\ (QO6

A@PK /@4!$8M`` P'&637#PL V\S^RM\QL QNMVU [XRU OPMO M PLMNOPQMRL YRX_V]LR O^R\S V\ OX M\ V\S^RM\QL

QXUYM\T

A@PK 8M``7The Health Care Finance Administrations standard form for submitting provideR SLR_VQL

QNMVUS OX OPVR] YMROT QXUYM\VLS XR V\S^RM\QL QMRRVLRS6 /:-( VS \X` QMNNL] :2"H SLL :2"6

A@PK$8JM`72XRL QXUUX\NT d\X`\ MS OPL $GK


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SLR_VQL6 $\]LR OPL/+3((3RV_MQT 0^NLH OPLSL MRL MNNX`MbNL SLS M\] ]VSQNXS^RLS X[ V]L\OV[VMbNL

information without specific authorization. Research is not considered part of health care operations.

A5+F0D @+&5 :&'S>25&73RX_V]LRS X[ UL]VQMN XR PLMNOP QMRL XR RLSLMRQPLRS `PX YRX_V]L PLMNOP QMRL MRLPLMNOP QMRL YRX_V]LRS6 )XRUMNNT PLMNOP QMRL YRX_V]LRS MRL QNV\VQSH PXSYVOMNSH ]XQOXRSH ]L\OVSOSH

YSTQPXNXWVSOS M\] SVUVNMR YRX[LSSVX\MNS6

A5+F0DR+&5 :&'S>25& *+V'1'6G @'25,B (\ M]UV\VSORMOV_L QX]L SLO OPMO QNMSSV[VLS PLMNOP QMRL YRX_V]LRS

bT OTYL M\] MRLM X[ SYLQVMNVcMOVX\6 #PL QX]L SLO `VNN bL ^SL] V\ QLROMV\ M]XYOL] ORM\SMQOVX\S6 =)XOLB (

WV_L\ YRX_V]LR UMT PM_L UXRL OPM\ X\L /LMNOPQMRL 3RX_V]LR #MZX\XUT :X]L6>

A5+F0D U6(F'G5& F>0G KR0 '; 8^^Q/A.:KK37 ( -L]LRMN NM` OPMO MNNX`S YLRSX\S

OX a^MNV[T VUUL]VMOLNT [XR QXUYMRMbNL PLMNOP V\S^RM\QL QX_LRMWL `PL\ OPLT QPM\WL OPLVR LUYNXTUL\O

RLNMOVX\SPVYS6 #PVS NLWVSNMOVX\ SLOS M YRLQL]L\O [XR -L]LRMN V\_XN_LUL\O V\ V\S^RM\QL RLW^NMOVX\6 +O SLOS

UV\VU^U SOM\]MR]S [XR RLW^NMOVX\ X[ OPL SUMNN WRX^Y V\S^RM\QL UMRdLO M\] [XR M SLO WRX^Y V\ OPLV\]V_V]^MN V\S^RM\QL UMRdLO V\ OPL MRLM X[ YXROMbVNVOT M\] M_MVNMbVNVOT X[ PLMNOP V\S^RM\QL6 (S M RLS^NO X[

OPVS NM`H PXSYVOMNSH ]XQOXRS M\] V\S^RM\QL QXUYM\VLS MRL \X` RLa^VRL] OX SPMRL YMOVL\O UL]VQMN RLQXR]S

M\] YLRSX\MN V\[XRUMOVX\ X\ M `V]LR bMSVS #PVS `V]L bMSL] SPMRV\W X[ UL]VQMN RLQXR]S PMS NL] OX YRV_MQT
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A5+F0D 4+>1051+1R5 W&T+1>c+0>'1 /A4W37/2,S X[[LR YRLYMV]H QXUYRLPL\SV_L PLMNOP QX_LRMWL [XR

bXOP PXSYVOMN M\] YPTSVQVM\ SLR_VQLS6 #PL /2, VS YMV] UX\OPNT YRLUVÛS XR QMYVOMOL] RMOLS bT OPL

YMTLRSH PVQP V\QN^]L LUYNXTLRSH V\S^RM\QL QXUYM\VLSH WX_LR\UL\O MWL\QVLSH M\] XOPLR WRX^YS

RLYRLSL\OV\W QX_LRL] NV_LS6 #PL /2, U^SO ULLO OPL SYLQV[VQMOVX\S X[ OPL [L]LRMN /2, MQO MS `LNN MS

ULLOV\W UM\T R^NLS M\] RLW^NMOVX\S RLa^VRL] MO OPL SOMOL NL_LN6 #PLRL MRL 9 bMSVQ UX]LNSB WRX^Y UX]LNH

V\]V_V]^MN YRMQOVQL MSSXQVMOVX\H \LO`XRd UX]LN M\] SOM[[ UX]LN6 (\ /2, QX\ORMQOS `VOP PLMNOP QMRL

YRX_V]LRSH L6W6H YPTSVQVM\SH PXSYVOMNSH M\] XOPLR PLMNOP YRX[LSSVX\MNS6 #PL ULUbLRS X[ M\ /2, MRL

RLa^VRL] OX ^SL YMROVQVYMOV\W XR MYYRX_L] YRX_V]LRS [XR MNN PLMNOP SLR_VQLS M\] WL\LRMNNT MNN SLR_VQLS `VNN

\LL] OX ULLO [^ROPLR MYYRX_MN bT OPL /2, OPRX^WP VOS ÔVNVcMOVX\ YRXWRMU6 2LUbLRS MRL L\RXNNL] [XR M

SYLQV[VL] YLRVX] X[ OVUL6 /2,S UMT O^R\ MRX^\] M\] S^bKQMYVOMOL OX XOPLR WRX^YS6 -XR LZMUYNLH VO UMT

QMR_LKXÔ QLROMV\ bL\L[VO QMOLWXRVLSH S^QP MS UL\OMN PLMNOPH M\] S^bKQMYVOMOL OPLSL OX M UL\OMN PLMNOP

/2,6 ,R OPL /2, UMT S^bKQMYVOMOL OX M YRX_V]LRH YRX_V]LR WRX^Y XR YRX_V]LR \LO`XRd6 /2,S MRL OPL

UXSO RLSORVQOV_L [XRU X[ UM\MWL] QMRL bL\L[VO YNM\S bLQM^SL OPLT RLSORVQO OPL YRXQL]^RLSH YRX_V]LRS M\]

bL\L[VOS6

A5F( K /LMNOP *L_LN @ ]XUMV\ VS OPL SOM\]MR]S [XR LNLQORX\VQ V\OLRQPM\WL X[ QNV\VQMNH

[V\M\QVMN M\] M]UV\VSORMOV_L V\[X MUX\W PLMNOPQMRL XRVL\OL] QXUYÔLR STSOLUS6 +S M \XOK[XRKYRX[VO

_XN^\OLLR XRWM\VcMOVX\6 +O ]L_LNXYS SYLQV[VQMOVX\SH UXSO `V]LNT ^SL] VS OPL ULSSMWV\W SOM\]MR] OPMO

L\MbNLS ]VSYMRMOL PLMNOP QMRL MYYNVQMOVX\S OX LZQPM\WL dLT SLOS X[ QNV\VQMN M\] M]UV\VSORMOV_L ]MOM6 +OYRXUXOLS OPL SL X[ SOM\]MR]S VOPV\ M\] MUX\W PLMNOPQMRL XRWM\VcMOVX\S OX V\QRLMSL OPL L[[LQOV_L\LSS

M\] L[[VQVL\QT X[ PLMNOPQMRL ]LNV_LRT6 +O VS M\ V\OLR\MOVX\MN QXUU^\VOT X[ PLMNOPQMRL S^bhLQO UMOOLR

O ] V [ OV V OV O NN b OV O O O ] ] [ OP P O ]


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.@'1+F A5+F0D *&+1,+R0>'1 !0+12+&2, '1 *5RD1'F'TG>B #PL ]L_LNXYUL\OH V\SOMNNMOVX\H M\] VUYNLUL\OMOVX\ X[ QXUY^OLR STSOLUS

M\] MYYNVQMOVX\S6

.125(512510 :&+R0>R5 K,,'R>+0>'1 /.:K37 '& W&T+1>c+0>'1 /.:W3 $( ]LNV_LRT UX]LN V\ `PVQP OPL /2,

QX\ORMQOS VOP M YPTSVQVM\ XRWM\VcMOVX\H PVQP V\ O^R\ QX\ORMQOS VOP V\]V_V]^MN YPTSVQVM\S6 #PL +3(

YPTSVQVM\S YRMQOVQL V\ OPLVR X`\ X[[VQLS M\] QX\OV\^L OX MNSX SLL OPLVR --" YMOVL\OS6 #PL /2, RLVUb^RSLSOPL +3( X\ M QMYVOMOL] bMSVSl PX`L_LRH OPL +3( UMT RLVUb^RSL OPL YPTSVQVM\S X\ M\ --" XR QMYVOMOL]

bMSVS6


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N'>10 @'66>,,>'1 '1 0D5 KRR&52>0+0>'1 '; A5+F0DR+&5 W&T+1>c+0>'1, /N@KAW>B -XRULRNT QMNNL] g:(/H XR

gXV\O :XUUVSSVX\ X\ (QQRL]VOMOVX\ X[ /XSYVOMNSH OPVS VS OPL YLLR RL_VL` XRWM\VcMOVX\ `PVQP YRX_V]LS OPL

YRVUMRT RL_VL` X[ PXSYVOMNS M\] PLMNOPQMRL YRX_V]LRS6 2M\T V\S^RM\QL QXUYM\VLS RLa^VRL YRX_V]LRS OX

PM_L OPVS MQQRL]VOMOVX\ V\ XR]LR OX SLLd CR]YMROT YMTUL\OH MNOPX^WPH UM\T SUMNN PXSYVOMNS QM\\XO M[[XR]

OPL QXSO X[ MQQRL]VOMOVX\6 g:(/, S^MNNT S^R_LTS XRWM\VcMOVX\S X\QL L_LRT C TLMRSH SL\]V\W V\ M UL]VQMN

M\] M]UV\VSORMOV_L OLMU OX RL_VL` YXNVQVLSH YMOVL\O RLQXR]SH YRX[LSSVX\MN QRL]L\OVMNV\W YRXQL]^RLSH

governance and quality improvement programs. JCAHO revises its standards annually.

n I o

I5G @'10&>#"0'& :F+1B #PVS RL[LRS OX M NVOONL d\X`\ YLR[XRUM\QLKbMSL] YRXWRMU VOP V\QL\OV_LS [XR OPL

Y^RYXSL X[ MOORMQOV\WH UXOV_MOV\W M\] RLOMV\V\W dLT V\]V_V]^MNS XR SUMNN WRX^YS6

n * o

YKE /Y'R+F K&5+ E50X'&-37( *() S^YYNVLS \LO`XRdV\W QMYMbVNVOT OX M WRX^Y X[ QXUYÔLRS V\ QNXSL

YRXZVUVOT OX LMQP XOPLR S^QP MS V\ M\ X[[VQL b^VN]V\WH M SQPXXNH XR M PXUL6

Y5T+RG !G,056,B :XUYÔLR MYYNVQMOVX\SH bXOP PMR]`MRL M\] SX[O`MRLH `PVQP PM_L bLL\ V\PLRVOL]

OPRX^WP YRL_VX^S MQa^VSVOVX\ M\] V\SOMNNMOVX\6 2XSO X[OL\H OPLSL STSOLUS R^\ b^SV\LSS MYYNVQMOVX\S OPMOMRL \XO V\OLWRMOL] `VOP LMQP XOPLR6 )L`LR STSOLUS `PVQP SORLSS XYL\ ]LSVW\ M\] ]VSORVbÔL] YRXQLSSV\W

QMYMQVOT MRL WRM]^MNNT RLYNMQV\W S^QP STSOLUS6

Y5T+RG !G,0567#LRU ^SL] OX ]LSQRVbL M\ XN] STSOLU =^S^MNNT PMR]`MRL M\] SX[O`MRL>H VL6 XN] UL]VQMN

bVNNV\W SX[O`MRL STSOLU6

Y5T+RG !G,056 .105T&+0>'17 *D5V\OLWRMOVX\ X[ ]MOM bLO`LL\ M NLWMQT STSOLU M\] SXUL XOPLR SX[O`MRL

YRXWRMU UXSO QXUUX\NT SV\W /*K@ SOM\]MR]S6YU:C /Y'1T>0"2>1+F :+0>510 C5R'&237*X\WVO^]V\MN 3MOVL\O 0LQXR] VS M\./0OPMO V\QN^]LS MNN PLMNOPQMRL

V\[XRUMOVX\ [RXU MNN SX^RQLS6
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49K9 /452>R+F K,,>,0+1037+[ QLROV[VL]H VS RL[LRRL] OX MS :2(6 "XUL QNV\VQS PM_L SVUVNMR YXSVOVX\S d\X`\ MS

:NV\VQMN (SSVSOM\OS6 $SL] V\ UXSO X[[VQLS MS M YMRO X[ OPL \^RSV\W SOM[[ VOP RLSYX\SVbVNVOVLS V\QN^]V\W

`XRdV\W ^Y YMOVL\OSH ORVMWV\W M\] RLO^R\V\W YMOVL\O QMNNS M\] MSSVSOV\W OPL YRX_V]LR V\ WL\LRMN6

2%B 2L]VQMN %XQOXR

4+1+T56510 .1;'&6+0>'1 !G,056 /4.!37#PL QXUUX\ OLRU [XR OPL QXUY^OLR PMR]`MRL M\] SX[O`MRL

OPMO YRX_V]LS OPL S^YYXRO X[ UM\MWV\W OPL YNM\6

4+,05& :+0>510 _ 456#5& .125VB (\ V\]LZ XR [VNL VOP M ^\Va^L V]L\OV[VLR [XR LMQP YMOVL\O XR ULUbLR

that serves as a key to a patients or members health record.

4+V>6"6 KFF'X+#F5 KR0"+F @D+&T5 /4KK@37( NVUVOMOVX\ X\ bVNNL] QPMRWLS [XR 2L]VQMRL SLR_VQLSYRX_V]L] bT \X\YMROVQVYMOV\W YPTSVQVM\S6 -XR YPTSVQVM\S `VOP QPMRWLS LZQLL]V\W 77; YLRQL\O X[ OPL

YRL_MVNV\W QPMRWL [XR \X\YMROVQVYMOV\W YPTSVQVM\SH 2((:S NVUVO V\QRLMSLS V\ MQO^MN QPMRWLS OX 7 YLRQL\O M

TLMR6 -XR YPTSVQVM\S `PXSL QPMRWLS MRL NLSS OPM\ 77; YLRQL\O X[ OPL YRL_MVNV\WH 2((:S NVUVO MQO^MN

QPMRWL V\QRLMSLS SX OPLT UMT \XO LZQLL] 77; YLRQL\O6

4+V>6"6 152 R+F *&+1,R&>(0>'17 ( 3%(KQXUYNVM\O UL]VQMN ORM\SQRVYOVX\ STSOLU OPMO UM\MWLS OPL ORM\SQRVYOVX\


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`VNN bL MS VUYXROM\O OX YPTSVQVM\S M\] UL]VQMN UM\MWLRS MS OPL R^NLS X[ [V\M\QVMN MQQX^\OV\W MRL OX

M^]VOXRS6

452>R+F 4+1+T56510 .1;'&6+0>'1 !G,056 /44.!37( ]MOM STSOLU OPMO MNNX`S YMTLRS M\] Y^RQPMSLRS OXORMQd PLMNOP QMRL LZYL\]VO^RL M\] OVNVcMOVX\ YMOOLR\S6 +O UMT MNSX bL RL[LRRL] OX MS /LMNOP +\[XRUMOVX\

"TSOLU =/+">H /LMNOP +\[XRUMOVX\ 2M\MWLUL\O =/+2> XR +\[XRUMOVX\ "TSOLU =+">6 "LL MNSX .NLQORX\VQ

2L]VQMN 0LQXR]=.20>6

4>2$F5S5F :&+R0>0>'15&70L[LRS OX OPL WRX^Y X[ YRX_V]LRS QX\SV]LRL] OX bL X\LKNL_LN bLNX` 26%6S M\]

%6,6S6 3PTSVQVM\ MSSVSOM\OS =36(6S> M\] )^RSL 3RMQOVOVX\LRS =)636S> MRL LZMUYNLS6

4'2>;>5&7( O`XKQPMRMQOLR QX]L M]]L] OX M :3# XR /:3:" QX]L OPMO VS ^SL] OX PLNY V\ OPL RLVUb^RSLUL\O

YRXQLSS6 -XR LZMUYNLH M UX]V[VLR QM\ bL ^SL] OX LZYNMV\ OPMO M YRXQL]^RL \XO \XRUMNNT QX_LRL] `PL\bVNNL] X\ OPL SMUL ]MT MS M\XOPLR VS MQO^MNNT M SLYMRMOL M\] SVW\V[VQM\O YRXQLSSH XR OPMO VO VS M R^RMN PLMNOP

YRXQL]^RL OPMO WLOS PVWPLR RLVUb^RSLUL\O6 $Y OX 9 UX]V[VLRS QM\ bL MOOMQPL] OX LMQP :3#H MNOPX^WP V\

UXSO QMSLS X\NT 7 XR ? MRL ^SL]6

4"F0>$!(5R>+F0G %&'"(7( WRX^Y X[ ]XQOXRS `PX RLYRLSL\O _MRVX^S UL]VQMN SYLQVMNOVLS M\] `PX `XRd

OXWLOPLR V\ M WRX^Y YRMQOVQL6

n ) o

E+0>'1+F @'"1R>F ;'& :&5,R&>(0>'1 '1+F


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S^YLR_VSVX\6 #PLT MRL LVOPLR SMNMRVL] XR RLVUb^RSL] X\ M [LLK[XRKSLR_VQL bMSVS6 )^RSL 3RMQOVOVX\LRS MRL

sometimes considered midlevel practitioners.

E:. /E+0>'1+F :&'S>25& .2510>;>5&37-MVRNT \L` J ]VWVO MNYPM\ÛLRVQ V]L\OV[VLR WV_L\ OX MNN UL]VQMN[MQVNVOVLS6 2XSO 26%6S M\] %," ]X \XO PM_L )3+S MO OPVS OVUL =OPLT SOVNN ^SL $3+) \ÛbLRS>6 /X`L_LRH

UV]KNL_LN YRMQOVOVX\LRS S^MNNT ]X6 )"- =)MOVX\MN "OM\]MR] -XRUMO>B "OM\]MR] [XRUMO [XR LNLQORX\VQ [VNV\W6

n , o

WRR"(+1RG C+057( ULMS^RL X[ V\YMOVL\O PLMNOP [MQVNVOT ^SLH ]LOLRUV\L] bT ]V_V]V\W M_MVNMbNL bL] ]MTS

by patient days. It measures the average percentage of a hospitals beds occupied and may be

V\SOVOÔVX\K`V]L XR SYLQV[VQ [XR X\L ]LYMROUL\O XR SLR_VQL6

W6#"2,(5&,'1 '& W6#"2,6+17( YLRSX\ `VOPV\ M UM\MWL] QMRL XRWM\VcMOVX\ XR M YLRSX\ XÔSV]L X[

OPL PLMNOP QMRL STSOLU =S^QP MS M\ MYYXV\OLL X[ OPL SOMOL> PX VS ]LSVW\MOL] OX RLQLV_L M\] V\_LSOVWMOL

QXUYNMV\OS [RXU bL\L[VQVMRVLS MbXÔ a^MNVOT X[ QMRLH V\MbVNVOT OX MQQLSS QMRLH ]VSQRVUV\MOVX\H M\] XOPLR

YRXbNLUS OPMO bL\L[VQVMRVLS UMT LZYLRVL\QL `VOP OPLVR UM\MWL] QMRL XRWM\VcMOVX\6 #PVS V\]V_V]^MN X[OL\

functions as the beneficiarys advocate in pursuing grievances or complaints about]L\VMNS X[ QMRL XR

V\MYYRXYRVMOL QMRL6 ,RWM\VcMOVX\S MRL UXSONT MbNL OX ]LSVW\MOL M ULUbLR X[ OPLVR X`\ SOM[[ MS

XUb^]SUM\6

W(51 KRR5,,7A term describing a members ability to selfKRL[LR [XR SYLQVMNOT QMRL6 ,YL\ MQQLSS

MRRM\WLUL\OS MNNX` M ULUbLR OX SLL M YMROVQVYMOV\W YRX_V]LR `VOPXÔ M RL[LRRMN [RXU M\XOPLR ]XQOXR6

Health plan members abilities, rights or invitation to self refer for specialty care. Also called Open Panel.

W(51 :+15F7A term describing a members ability to selfKRL[LR [XR SYLQVMNOT QMRL6 ,YL\ MQQLSS

MRRM\WLUL\OS MNNX` M ULUbLR OX SLL M YMROVQVYMOV\W YRX_V]LR `VOPXÔ M RL[LRRMN [RXU M\XOPLR ]XQOXR6

Health plan members abilities, rights or invitation to self refer for specialty care. Also called Open(QQLSS6

W"0R'65B ( QNV\VQMN XÔQXUL VS OPL RLS^NO X[ UL]VQMN XR S^RWVQMN V\OLR_L\OVX\ XR \X\V\OLR_L\OVX\ XR OPL


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LZVSOS V\ OPL UL]VQMN [VLN] MbXÔ OPL ]L[V\VOVX\ X[ XÔQXUL VOSLN[6 ( OXXN OX MSSLSS OPL VUYMQO X[ PLMNOP

SLR_VQLS V\ OLRUS X[ VUYRX_L] a^MNVOT M\]1XR NX\WL_VOT X[ NV[L M\] [^\QOVX\V\W6

W"0R'65, C5,5+&RDB 0LSLMRQP X\ ULMS^RLS X[ QPM\WLS V\ YMOVL\O XÔQXULSH OPMO VSH YMOVL\O PLMNOPSOMO^S M\] SMOVS[MQOVX\H RLS^NOV\W [RXU SYLQV[VQ UL]VQMN M\] PLMNOP V\OLR_L\OVX\S6 (OORVbÔV\W QPM\WLS V\

XÔQXULS OX UL]VQMN QMRL RLa^VRLS ]VSOV\W^VSPV\W OPL L[[LQOS X[ QMRL [RXU OPL L[[LQOS X[ OPL UM\T XOPLR

factors that influence patients health and satisfaction. With the elimination of the physicians fiduciary

RLSYX\SVbVNVOT OX OPL YMOVL\OH XÔQXULS ]MOM VS WMV\V\W V\QRLMSV\W VUYXROM\QL [XR YMOVL\O M]_XQMQT M\]

QX\SÛLR YRXOLQOVX\6 ,ÔQXULS RLSLMRQP `VNN MNSX bL ^SL] V\ OPL [Ô^RL bT YMTLRS OX V]L\OV[T YXOL\OVMN

YMRO\LRS X\ OPL bMSVS X[ WXX] XÔQXULS6

W"0(+0>510 @+&5B :MRL WV_L\ M YLRSX\ `PX VS \XO bL]RV]]L\6 +O VS MNSX QMNNL] MUb^NMOXRT QMRL6 2M\TS^RWLRVLS M\] ORLMOUL\OS MRL \X` YRX_V]L] X\ M\ XÔYMOVL\O bMSVSH `PVNL YRL_VX^SNT OPLT PM] bLL\

QX\SV]LRL] RLMSX\ [XR V\YMOVL\O PXSYVOMNVcMOVX\6 "XUL SMT OPVS VS OPL [MSOLSO WRX`V\W SLWUL\O X[

PLMNOPQMRL6

W;;>R5 =>,>0 Y5S5F,B ,OPLR`VSL d\X` MS .'2 QX]LSH OPL QX]L _MRVLS [RXU *L_LN + OX A ]LYL\]V\W X\

QXUYNLZVOT `VOP A bLV\W OPL UXSO QXUYNLZ6

n 3 o

:+,0 452>R+F A>,0'&G? :+,0 !"&T>R+F A>,0'&G? !R&551>1T /:4!!37#PVS VS M NVSO X[ MNN OPL YMSO S^RWLRT M\]

UL]VQMN VSS^LS OPMO OPL YMOVL\O PMS bLL\ ORLMOL] [XR6

:+0>510 Y>+#>F>0G7#PL ]XNNMR MUX^\O OPMO M\ V\S^RL] VS NLWMNNT XbNVWMOL] OX YMT [XR SLR_VQLS RL\]LRL] bT M

YRX_V]LR6 #PLSL UMT V\QN^]L QXKYMTUL\OSH ]L]^QOVbNLS M\] YMTUL\OS [XR \QX_LRL] SLR_VQLS6

:9K9 /:DG,>R>+1 K,,>,0+1037( UV]Klevel provider. They are required to have a Bachelors degree and then

MOOL\] M RVWXRX^S CKTLMR ORMV\V\W YRXWRMU UMV\NT V\SOR^QOL] bT YPTSVQVM\S6 #PLT MRL \XO YPTSVQVM\SH bÔ

V\ UXSO SOMOLS PM_L SVUVNMR RVWPOS M\] YRV_VNLWLS6 /X`L_LRH OPLT U^SO bL S^YLR_VSL] bT M YPTSVQVM\6


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GL\L[VQVMRVLS MRL RLSYX\SVbNL [XR ]L]^QOVbNLS M\] QXYMTUL\OS6 3MRO ( SLR_VQLS MRL [V\M\QL] bT OPL

2L]VQMRL /+ #R^SO -^\]H `PVQP QX\SVSOS X[ 2L]VQMRL OMZ YMTUL\OS6 3MRO GH X\ OPL XOPLR PM\]H RL[LRS OX

XÔYMOVL\O QX_LRMWL6

:+&0 L 452>R+&570L[LRS OX OPL XÔYMOVL\O bL\L[VOS X[ 2L]VQMRL6 2L]VQMRL "^YYNLUL\OMRT 2L]VQMN

+\S^RM\QL ="2+> \]LR 3MRO G X[ #VONL EA++ X[ OPL "XQVMN "LQ^RVOT (QO QX_LRS 2L]VQMRL bL\L[VQVMRVLS [XR

YPTSVQVM\ SLR_VQLSH UL]VQMN S^YYNVLSH M\] XOPLR XÔYMOVL\O ORLMOUL\O6 GL\L[VQVMRVLS MRL RLSYX\SVbNL [XR

UX\OPNT YRLUVÛSH QXYMTUL\OSH ]L]^QOVbNLSH M\] bMNM\QL bVNNV\W6 3MRO G SLR_VQLS MRL [V\M\QL] bT M

QXUbV\MOVX\ X[ L\RXNNLL YRLUVÛS M\] WL\LRMN OMZ RL_L\^LS6

:+&0>R>(+0>1T :&'S>25&7(\T YRX_V]LR NVQL\SL] V\ OPL SOMOL X[ YRX_VSVX\ M\] QX\ORMQOL] `VOP M\ V\S^RLR6

$S^MNNT OPVS RL[LRS OX YRX_V]LRS `PX MRL M YMRO X[ M \LO`XRd6 #PMO \LO`XRd `X^N] bL M YM\LN X[YMROVQVYMOV\W YRX_V]LRS6 3MTLRS MSSLUbNL OPLVR X`\ YRX_V]LR YM\LNS6

:+G5& /","+FFG *D>&2 :+&0G :+G5&37#PL Y^bNVQ XR YRV_MOL XRWM\VcMOVX\ OPMO VS RLSYX\SVbNL [XR YMTUL\O [XR

PLMNOP QMRL LZYL\SLS6 3MTLRS UMT bL V\S^RM\QL QXUYM\VLS XR SLN[KV\S^RL] LUYNXTLRS6

:@ L+,527( YRXWRMU ]LSVW\L] OX R^\ X\ M\ V\]V_V]^MN 3:6 #PVS OTYVQMNNT ULM\S ]MOM VS \XO SPMRL] V\ RLMN

OVUL MUX\W XOPLR 3:S =^SLRS>6

:@:73RVUMRT QMRL YPTSVQVM\ `PX X[OL\ MQOS MS OPL YRVUMRT WMOLdLLYLR V\ PLMNOP YNM\S6 #PMO VSH X[OL\ OPL

3:3 U^SO MYYRX_MN RL[LRRMNS OX SYLQVMNVSOS6 3MROVQ^NMRNT V\ /2,S M\] SXUL 33,SH MNN ULUbLRS U^SO

QPXXSL XR MRL MSSVW\L] M 3:36

:AC7( YLRSX\MN PLMNOP RLQXR] XR 3/0 VS OTYVQMNNT M PLMNOP RLQXR] OPMO VS V\VOVMOL] M\] UMV\OMV\L] bT M\

V\]V_V]^MN6 (\ V]LMN 3/0 `X^N] YRX_V]L M QXUYNLOL M\] MQQ^RMOL SÛUMRT X[ OPL PLMNOP M\] UL]VQMN

PVSOXRT X[ M\ V\]V_V]^MN bT WMOPLRV\W ]MOM [RXU UM\T SX^RQLS M\] UMdV\W OPVS V\[XRUMOVX\ MQQLSSVbNL

X\NV\L6

:DG,>R>+1 K005,0+0>'17#PL RLa^VRLUL\O OPMO OPL MOOL\]V\W YPTSVQVM\ QLROV[TH V\ `RVOV\WH OPL MQQ^RMQT M\]

QXUYNLOVX\ X[ OPL QNV\VQMN V\[XRUMOVX\ ^SL] [XR %04 MSSVW\UL\O


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:&+R0>R5 :+&+6505&,? :&+R0>R5 %">25F>15,7 "TSOLUMOVQMNNT ]L_LNXYL] SOMOLUL\OS OX SOM\]MR]VcL QMRL M\]

OX MSSVSO V\ YRMQOVOVX\LR M\] YMOVL\O ]LQVSVX\S MbXÔ OPL MYYRXYRVMOL PLMNOP QMRL [XR SYLQV[VQ

QVRQÛSOM\QLS6 3RMQOVQL W^V]LNV\LS MRL S^MNNT ]L_LNXYL] OPRX^WP M YRXQLSS OPMO QXUbV\LS SQVL\OV[VQ

L_V]L\QL X[ L[[LQOV_L\LSS `VOP LZYLRO XYV\VX\6 3RMQOVQL W^V]LNV\LS MRL MNSX RL[LRRL] OX MS QNV\VQMN QRVOLRVMHYRXOXQXNSH MNWXRVOPUSH RL_VL` QRVOLRVMH M\] W^V]LNV\LS6 #PL (ULRVQM\ 2L]VQMN (SSXQVMOVX\ ]L[V\LS YRMQOVQL

YMRMULOLRS MS SORMOLWVLS [XR YMOVL\O UM\MWLUL\OH ]L_LNXYL] OX MSSVSO YPTSVQVM\S V\ QNV\VQMN ]LQVSVX\K

UMdV\W6 3RMQOVQL YMRMULOLRS UMT MNSX bL RL[LRRL] OX MS YRMQOVQL XYOVX\SH YRMQOVQL W^V]LNV\LSH YRMQOVQL

YXNVQVLSH XR YRMQOVQL SOM\]MR]S6

:&5$K"0D'&>c+0>'17( QXSO QX\OMV\UL\O [LMO^RL X[ UM\T WRX^Y UL]VQMN YXNVQVLS `PLRLbT OPL V\S^RL]

U^SO QX\OMQO OPL V\S^RLR YRVXR OX M PXSYVOMNVcMOVX\ XR S^RWLRT M\] RLQLV_L MÔPXRVcMOVX\ [XR

:&>6+&G @+&57GMSVQ XR WL\LRMN PLMNOP QMRL S^MNNT RL\]LRL] bT WL\LRMN YRMQOVOVX\LRSH [MUVNT

YRMQOVOVX\LRSH V\OLR\VSOSH XbSOLORVQVM\S M\] YL]VMORVQVM\S PX MRL X[OL\ RL[LRRL] OX MS YRVUMRT QMRL

YRMQOVOVX\LRS XR 3:3S6 3RX[LSSVX\MN M\] RLNMOL] SLR_VQLS M]UV\VSOLRL] bT M\ V\OLR\VSOH [MUVNT YRMQOVOVX\LRH

XbSOLORVQVM\KWT\LQXNXWVSO XR YL]VMORVQVM\ V\ M\ MUb^NMOXRT SLOOV\WH VOP RL[LRRMN OX SLQX\]MRT QMRL

SYLQVMNVSOSH MS \LQLSSMRT6

:&>6+&G @+&5 E50X'&- /:@E37( WRX^Y X[ YRVUMRT QMRL YPTSVQVM\S `PX SPMRL OPL RVSd X[ YRX_V]V\W QMRL OX

ULUbLRS X[ M WV_L\ PLMNOP YNM\6

:&>6+&G @+&5 :DG,>R>+1? /:@:37A generalist such as a family practitioner, pediatrician, internist, or

XbSOLORVQVM\6 +\ M UM\MWL] QMRL XRWM\VcMOVX\H M YRVUMRT QMRL YPTSVQVM\ VS MQQX^\OMbNL [XR OPL OXOMN PLMNOP

SLR_VQLS X[ L\RXNNLLS V\QN^]V\W RL[LRRMNSH YRXQL]^RLS M\] PXSYVOMNVcMOVX\6 (NSX SLL 3RVUMRT :MRL 3RX_V]LR6

:&>6+&G @+&5 :&'S>25& /:@:37#PL YRX_V]LR OPMO SLR_LS MS OPL V\VOVMN V\OLR[MQL bLO`LL\ OPL ULUbLR M\]

OPL UL]VQMN QMRL STSOLU6 #PL 3:3 VS ^S^MNNT M YPTSVQVM\H SLNLQOL] bT OPL ULUbLR ^YX\ L\RXNNUL\OH `PX

VS ORMV\L] V\ X\L X[ OPL YRVUMRT QMRL SYLQVMNOVLS PX ORLMOS M\] VS RLSYX\SVbNL [XR QXXR]V\MOV\W OPLORLMOUL\O X[ ULUbLRS MSSVW\L] OX PVS1PLR YNM\6 "LL MNSX 4MOLdLLYLR6

:&>1R>(+F +T1',>,B The medical condition that is ultimately determined to have caused a patients


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CK.< /C52"12+10 K&&+G '; .125(512510 ,-,37( `MT X[ SOXRV\W OPL SMUL ]MOM V\ ]V[[LRL\O YNMQLS X\

U^NOVYNL PMR] ]VSdS6 ,[OL\ ^SL] X\ SLR_LRS OX YRX_V]L RL]^\]M\QT V\ OPL L_L\O X[ M PMR] ]RV_L [MVN^RL6

C5+F *>65B #PL V\SOM\OM\LX^S SPMRV\W X[ ]MOM MUX\W M SLR WRX^Y6 +O VS QXUUX\ OX M QNVL\O1SLR_LR]MOMbMSL QX\[VW^RMOVX\6

C5;5&&+FB "XUL V\S^RM\QL QXUYM\VLS RLa^VRL OPMO X\ SYLQV[VQ YNM\S M RL[LRRMN U^SO bL XbOMV\L] [XR

QLROMV\ YRXQL]^RLS XR _VSVOS OX SYLQVMNVSOS6 #PL RL[LRRMN VS MQa^VRL] bT OPL YRVUMRT QMRL YPTSVQVM\ =3:3> bT

QX\OMQOV\W OPL V\S^RM\QL QXUYM\T bT YPX\L XR UMVN6 #PVS VS M RLa^LSO [XR OPL SLR_VQL6 #PL RL[LRRMN

QX\SVSOS X[ M\ MÔPXRVcMOVX\ QX]LH M \ÛbLR X[ _VSVOS MNNX`L] =V[ MYYNVQMbNL> M\] M\ LZYVRMOVX\ ]MOL6

C5;5&&>1T :&'S>25&B VS OPL YRX_V]LR OPMO RL[LRRL] OPL YMOVL\O OX M SYLQVMNVSO XR [XR M SYLQV[VQ YRXQL]^RL6

C5F+0>'1+F OX LMQP XOPLR6

C56'05 KRR5,,7%MOM ORM_LNS OPRX^WP M YRV_MOLH YRXOLQOL] YMSSMWL _VM OPL +\OLR\LOH MNNX`V\W PLMNOPQMRL

YRX_V]LRS OX MQQLSS [RXU PXUL XR M\XOPLR YRMQOVQL NXQMOVX\ M\] MNNX`S .20 _L\]XR OX YLR[XRU STSOLU

UMV\OL\M\QL X[[KSVOL

C5125&>1T_:5&;'&6>1T :&'S>25&B #PL YRX_V]LR MQO^MNNT ORLMOV\W OPL YMOVL\O6

Registered Nurses (R.N.s):Registered nurses are responsible for carrying out the physicians

V\SOR^QOVX\S6 #PLT S^YLR_VSL YRMQOVQMN \^RSLS M\] XOPLR M^ZVNVMRT YLRSX\\LN PX YLR[XRU RXÔV\L QMRL

M\] ORLMOUL\O X[ YMOVL\OS6 0LWVSOLRL] \^RSLS YRX_V]L \^RSV\W QMRL OX YMOVL\OS XR YLR[XRU SYLQVMNVcL]

]ÔVLS V\ M _MRVLOT X[ SLOOV\WS [RXU PXSYVOMN M\] QNV\VQS OX SQPXXNS M\] Y^bNVQ PLMNOP ]LYMROUL\OS6 (

NVQL\SL OX YRMQOVQL \^RSV\W VS RLa^VRL] V\ MNN SOMOLS6 -XR NVQL\S^RL MS M RLWVSOLRL] \^RSL =06)6>H M\ MYYNVQM\O

U^SO PM_L WRM]^MOL] [RXU M SQPXXN X[ \^RSV\W MYYRX_L] bT OPL SOMOL bXMR] [XR \^RSV\W M\] PM_L YMSSL]

M SOMOL bXMR] LZMUV\MOVX\6

CW! /C5S>5X '; !G,056,37 ( SLRVLS X[ a^LSOVX\S RLNMOL] OX OPL STSOLU=S> OPMO OPL YMOVL\O VS PM_V\W


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*D>1 @F>5107(NSX d\X` as a Dummy Terminal is a network computer without a hardK]RV_L `PVQP

RLa^VRLS OPL QX\SOM\O QX\\LQOVX\ OX M SLR_LR OX XYLRMOL6

*&>+F L+F+1R57( ]LOMVNL] RLYXRO X[ V\_XVQLS [XR M YMOVL\O6

*&5+065107#PL YRX_VSVX\ X[ PLMNOP QMRL bT X\L XR UXRL PLMNOP QMRL YRX_V]LRS6 #RLMOUL\O V\QN^]LS M\Tconsultation, referral or other exchanges of information to manage a patients care. The HIPAA Privacy

)XOVQL LZYNMV\S OPMO OPL/+3((3RV_MQT 0^NL MNNX`S 3MRO\LRS M\] VOS M[[VNVMOLS OX SL M\] ]VSQNXSL

YRXOLQOL] PLMNOP V\[XRUMOVX\ [XR ORLMOUL\O Y^RYXSLS `VOPXÔ SYLQV[VQ MÔPXRVcMOVX\6

*&5+06510 U(>,'257#PL YLRVX] X[ ORLMOUL\O bLO`LL\ M]UVSSVX\ M\] ]VSQPMRWL [RXU M UX]MNVOTH L6W6H

V\YMOVL\OH RLSV]L\OVMNH YMROVMN PXSYVOMNVcMOVX\H M\] XÔYMOVL\OH XR OPL YLRVX] X[ OVUL bLO`LL\ OPL [VRSO

YRXQL]^RL M\] NMSO YRXQL]^RL X\ M\ XÔYMOVL\O bMSVS [XR M WV_L\ ]VMW\XSVS6 2M\T PLMNOPQMRL SOMOVSOVQS

M\] YRX[VNLS ^SL OPVS ^\VO MS M bMSL [XR QXUYMRVSX\S6

n $ o\L$^B $ \1>;'&6 L>FF>1T @'25 '; 8^^BB GVNN [XRU ^SL] OX S^bUVO PXSYVOMN V\S^RM\QL

EHR Standards-V2R - Task SubGrps I ,II & III-Oct-12[3]

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Transcript of EHR Standards-V2R - Task SubGrps I ,II & III-Oct-12[3]