Achieving the Health IT Objectives of the
American Recovery and Reinvestment Act

A Framework for 'Meaningful Use' and 'Certified or Qualified' Electronic Health Records

Health IT Provisions Under ARRA:
Appendix A

Purpose	Available 'Good Enough' Standard(s)In several cases, the HIT Standards Committee will need to recommend specific versions of standards. Mappings between vocabularies (e.g. CPT4 ßà Snomed CT), although never perfect, can be accomplished via efforts such as the Unified Medical Language System (UMLS), or via proprietary solutions. It is assumed that these standards will continue to evolve and adapt. Most of the standards listed here have implementation guides (e.g., NCPDP SCRIPT).
Transport
Enable server to server security	SSL, TLS
Enable secure file transport	HTTPSSpecification of transport and security standards will need to be accompanied by definitions of network interfaces, specified as uniform resource locators (URLs) and the way of methods or processes that can be invoked at these network interfaces. This degree of specification will be required if any two participants in the system are to be able to work together without requiring advance coordination for each potential pair of communicating entities (which would create impossible complexity as the network grows large).
Codify Content
Codify diagnostic tests	LOINC, CPT4, Snomed CT
Codify medicationsMedication notes: NDC includes prescription medications only; RxNorm includes OTC medications. RxNorm allows for varying hierarchical representations of medication data (from name to name, strength and form). Pharmacists have greater use for the non-clinical information within an NDC code than other clinicians: e.g. packaging type/size, manufacturer, etc. The medication SIG (i.e., doctor's instructions for taking the medication and other data) is not covered here, but needs to be part of a retail medication feed in order for doctors, pharmacists and patients to maximally benefit from medication information. The NCPDP Structured and Codified SIG Standard is being piloted.	RxNorm (or RxTerm), NDC
Package
Create a clinical summary data package (XML)	CDA CCD, CCR standard
Create an e-prescribing data package (XML)	NCPDP SCRIPT
Create a lab data package	HL7 v2 (XML serialized version preferred when feasible, but delimited data acceptable)
Create an administrative data package	X12
Images
Facilitate image interoperability between medical imaging systems	DICOMBecause DICOM (Digital Imaging and Communications in Medicine) is both a communication and content standard, 'images' have been categorized separately.