Federal Register. Edition Health Information Technology Health IT Certification Criteria, 2. Edition Base Electronic Health Record EHR Definition, and ONC Health IT Certification Program Modifications. Start Preamble. Start Printed Page 6. AGENCY Office of the National Coordinator for Health Information Technology ONC, Department of Health and Human Services HHS. ACTION Final rule. I/51HVTQ-VcgL._SR600%2C315_PIWhiteStrip%2CBottomLeft%2C0%2C35_PIStarRatingFOUR%2CBottomLeft%2C360%2C-6_SR600%2C315_ZA(28%20Reviews)%2C445%2C286%2C400%2C400%2Carial%2C12%2C4%2C0%2C0%2C5_SCLZZZZZZZ_.jpg' alt='Medical Terminology Made Easy Fourth Edition Building' title='Medical Terminology Made Easy Fourth Edition Building' />SUMMARY This final rule finalizes a new edition of certification criteria the 2. Edition health IT certification criteria or 2. Edition and a new 2. Edition Base Electronic Health Record EHR definition, while also modifying the ONC Health IT Certification Program to make it open and accessible to more types of health IT and health IT that supports various care and practice settings. The 2. 01. 5 Edition establishes the capabilities and specifies the related standards and implementation specifications that Certified Electronic Health Record Technology CEHRT would need to include to, at a minimum, support the achievement of meaningful use by eligible professionals EPs, eligible hospitals, and critical access hospitals CAHs under the Medicare and Medicaid EHR Incentive Programs EHR Incentive Programs when such edition is required for use under these programs. DATES These regulations are effective January 1. April 1, 2. 01. 6. The incorporation by reference of certain publications listed in the rule is approved by the Director of the Federal Register as of January 1. Start Further Info. FOR FURTHER INFORMATION CONTACT Michael Lipinski, Office of Policy, Office of the National Coordinator for Health Information Technology, 2. End Further Info. End Preamble. Start Supplemental Information. SUPPLEMENTARY INFORMATION Commonly Used Acronyms. API Application Programming Interface. CAH Critical Access Hospital. CDA Clinical Document Architecture. CDC Centers for Disease Control and Prevention. CDS Clinical Decision Support. CEHRT Certified Electronic Health Record Technology. CFR Code of Federal Regulations. CHPL Certified Health IT Product List. Find Non Ascii Characters In Text File Notepad2. CLIA Clinical Laboratory Improvement Amendments. CMS Centers for Medicare Medicaid Services. Theres nothing unique about loving Lego. Millions of people wax nostalgic when they see those colorful bricks. Millions more never stopped building. Ive always. Automatic works cited and bibliography formatting for MLA, APA and ChicagoTurabian citation styles. Now supports 7th edition of MLA. A sample of Scientologese The below was written by sdraper, and posted to alt. Technical Dictionary and Science of. Web portal for buildingrelated information with a whole building focus provided by the National Institute of Building Sciences. Areas include Design Guidance. A practical siphon, operating at typical atmospheric pressures and tube heights, works because gravity pulling down on the taller column of liquid leaves reduced. CQM Clinical Quality Measure. EHR Electronic Health Record. FDA Food and Drug Administration. HHS Department of Health and Human Services. HISP Health Information Service Providers. HIT Health Information Technology. HITPC HIT Policy Committee. HITSC HIT Standards Committee. HL7 Health Level Seven. IG Implementation Guide. LOINC Logical Observation Identifiers Names and Codes. NIST National Institute of Standards and Technology. ONC Office of the National Coordinator for Health Information Technology. SDO Standards Developing Organization. SNOMED CT Systematized Nomenclature of Medicine Clinical Terms. Table of Contents. I. Executive Summary. A. Purpose of Regulatory Action. B. Summary of Major Provisions. Overview of the 2. Edition Health IT Certification Criteria. Health IT Definitions 3. The ONC Health IT Certification Program and Health IT Module. C. Costs and Benefits II. Background. A. Statutory Basis. Standards, Implementation Specifications, and Certification Criteria. HIT Certification Programs. B. Regulatory History. Standards, Implementation Specifications, and Certification Criteria Rules. Medicare and Medicaid EHR Incentive Programs Rules 3. ONC Health IT Certification Programs Rules. III. Provisions of the Proposed Rule Affecting Standards, Implementation Specifications, Certification Criteria, and Definitions. A. 2. 01. 5 Edition Health IT Certification Criteria. Applicability. 2. Standards and Implementation Specifications. Adopted Certification Criteria. Edition Gap Certification Eligibility Table. Not Adopted Certification Criteria. B. Health IT Definitions. Base EHR Definitions 2. Certified EHR Technology Definition. Common Clinical Data Set Definition. Cross Referenced FDA Definitions. IV. Provisions of the Proposed Rule Affecting the ONC Health IT Certification Program. A. Subpart EONC Health IT Certification Program B. Modifications to the ONC Health IT Certification Program. Health IT Modules. Removal of Meaningful Use Measurement Certification Requirements. Types of Care and Practice Settings. Referencing the ONC Health IT Certification Program. C. Health IT Module Certification Requirements 1. Privacy and Security. Design and Performance  1. D. Principles of Proper Conduct for ONC ACBs. In the Field Surveillance and Maintenance of Certification. Transparency and Disclosure Requirements. Open Data Certified Health IT Product List CHPL4. Records Retention. Complaints Reporting 6. Adaptations and Updates of Certified Health ITE. Decertification of Health ITRequest for Comments. V. Incorporation by Reference. VI. Collection of Information Requirements. VII. Regulatory Impact Statement. A. Statement of Need. B. Overall Impact. Executive Orders 1. Regulatory Planning and Review Analysis 2. Regulatory Flexibility Act. Executive Order 1. Federalism 4. Unfunded Mandates Reform Act of 1. Regulation Text. I. Executive Summary. A. Purpose of Regulatory Action. Building on past rulemakings, we issued a proposed rule Proposed Rule 8. FR 1. 68. 04 that identified how health IT certification to the proposed 2. Edition health IT certification criteria could support the establishment of an interoperable nationwide health information infrastructure. The Proposed Rule reflected stakeholder feedback received through various outreach initiatives, including the regulatory process, and was designed to broadly support the health care continuum through the use of certified health IT. This final rule, taking into account public comments received on the Proposed Rule, continues to focus on the establishment of an interoperable nationwide health information infrastructure, through the same means identified in the Proposed Rule and recited below, but with an additional focus on reducing health IT developer and provider burden as compared to the Proposed Rule. To this end, this final rule will Improve interoperability for specific purposes by adopting new and updated vocabulary and content standards for the structured recording and exchange of health information, including a Common Clinical Data Set composed primarily of data expressed using adopted standards and rigorously testing an identified content exchange Start Printed Page 6. Consolidated Clinical Document Architecture C CDA Facilitate the accessibility and exchange of data by including enhanced data export, transitions of care, and application programming interface API capabilities in the 2. Edition Base Electronic Health Record EHR definition Establish a framework that makes the Office of the National Coordinator for Health Information Technology ONC Health IT Certification Program open and accessible to more types of health IT, health IT that supports a variety of care and practice settings, various HHS programs, and public and private interests Support the Centers for Medicare Medicaid Services CMS Medicare and Medicaid EHR Incentive Programs EHR Incentive Programs through the adoption of a set of certification criteria that align with proposals for Stage 3 Address health disparities by providing certification to standards for more granular capture of race and ethnicity the collection of sexual orientation, gender identity, social, psychological, and behavioral data for the exchange of sensitive health information Data Segmentation for Privacy and for the accessibility of health IT Ensure all health IT presented for certification possess the relevant privacy and security capabilities Improve patient safety by applying enhanced user centered design principles to health IT, enhancing patient matching, requiring health IT to be capable of exchanging relevant patient information e. Siphon Wikipedia. Figure 2 In the flying droplet siphon, surface tension pulls the stream of liquid into separate droplets inside of a sealed, air filled chamber, preventing the liquid going down from having contact with the liquid going up, and thereby preventing liquid tensile strength from pulling the liquid up. It also demonstrates that the effect of atmospheric pressure at the entrance is not canceled by the equal atmospheric pressure at the exit. The word siphon SY fn 1 from Ancient Greek pipe, tube, also spelled syphon is used to refer to a wide variety of devices that involve the flow of liquids through tubes. In a narrower sense, the word refers particularly to a tube in an inverted U shape, which causes a liquid to flow upward, above the surface of a reservoir, with no pump, but powered by the fall of the liquid as it flows down the tube under the pull of gravity, then discharging at a level lower than the surface of the reservoir from which it came. There are two leading theories about how siphons cause liquid to flow uphill, against gravity, without being pumped, and powered only by gravity. The traditional theory for centuries was that gravity pulling the liquid down on the exit side of the siphon resulted in reduced pressure at the top of the siphon. Then atmospheric pressure was able to push the liquid from the upper reservoir, up into the reduced pressure at the top of the siphon, like in a barometer or drinking straw, and then over. However, it has been demonstrated that siphons can operate in a vacuum5678 and to heights exceeding the barometric height of the liquid. Consequently, the cohesion tension theory of siphon operation has been advocated, where the liquid is pulled over the siphon in a way similar to the chain model. It need not be one theory or the other that is correct, but rather both theories may be correct in different circumstances of ambient pressure. The atmospheric pressure with gravity theory obviously cannot explain siphons in vacuum, where there is no significant atmospheric pressure. But the cohesion tension with gravity theory cannot explain CO2 gas siphons,1. All known published theories in modern times recognize Bernoullis equation as a decent approximation to idealized, friction free siphon operation. HistoryeditEgyptian reliefs from 1. BC depict siphons used to extract liquids from large storage jars. There is physical evidence for the use of siphons by Greek engineers in the 3rd century BC at Pergamon. Hero of Alexandria wrote extensively about siphons in the treatise Pneumatica. The Banu Musa brothers of 9th century Baghdad invented a double concentric siphon, which they described in their Book of Ingenious Devices. The edition edited by Hill includes an analysis of the double concentric siphon. Siphons were studied further in the 1. This was initially explained by Galileo Galilei via the theory of horror vacui nature abhors a vacuum, which dates to Aristotle, and which Galileo restated as resintenza del vacuo, but this was subsequently disproved by later workers, notably Evangelista Torricelli and Blaise Pascal1. The chain model where the section marked B pulls down because it is heavier than the section A is a flawed but useful analogy to the operation of a siphon. A practical siphon, operating at typical atmospheric pressures and tube heights, works because gravity pulling down on the taller column of liquid leaves reduced pressure at the top of the siphon formally, hydrostatic pressure when the liquid is not moving. This reduced pressure at the top means gravity pulling down on the shorter column of liquid is not sufficient to keep the liquid stationary against the atmospheric pressure pushing it up into the reduced pressure zone at the top of the siphon. So the liquid flows from the higher pressure area of the upper reservoir, up to the lower pressure zone at the top of the siphon, over the top, and then with the help of gravity and a taller column of liquid, down to the higher pressure zone at the exit. The chain model is a useful but not completely accurate conceptual model of a siphon. The chain model helps to understand how a siphon can cause liquid to flow uphill, powered only by the downward force of gravity. A siphon can sometimes be thought of a little like a chain hanging over a pulley, with one end of the chain piled on a higher surface than the other. Since the length of chain on the shorter side is lighter than the length of chain on the taller side, the heavier chain on the taller side will move down and pull up the chain on the lighter side. Similar to a siphon, the chain model is obviously just powered by gravity acting on the heavier side, and there is clearly no violation of conservation of energy, because the chain is ultimately just moving from a higher to a lower location, as the liquid does in a siphon. Even the falling lighter lower leg from C to D can cause the liquid of the heavier upper leg to flow up and over into the lower reservoir2. There are a number of problems with the chain model of a siphon, and understanding these differences helps to explain the actual workings of siphons. First, unlike in the chain model of the siphon, it is not actually the weight on the taller side compared to the shorter side, that matters. Rather it is the difference in height from the reservoir surfaces to the top of the siphon, that determines the balance of pressure. For example, if the tube from the upper reservoir to the top of the siphon has a much larger diameter than the taller section of tube from the lower reservoir to the top of the siphon, the shorter upper section of the siphon may have a much larger weight of liquid in it, and yet the lighter volume of liquid in the down tube can pull liquid up the fatter up tube, and the siphon can function normally. Another difference is that under most practical circumstances, dissolved gases, vapor pressure, and sometimes lack of adhesion with tube walls, conspire to render the tensile strength within the liquid ineffective for siphoning. Thus, unlike a chain which has significant tensile strength, liquids usually have little tensile strength under typical siphon conditions, and therefore the liquid on the rising side cannot be pulled up, in the way the chain is pulled up on the rising side. Figure 5 Air Start Siphon When the column of liquid is allowed to fall from C down to D, liquid in the upper reservoir will flow up to B and over the top. No liquid tensile strength is needed to pull the liquid up. Demonstration of siphoning tropical fruit punch with a flying droplet siphon. An occasional misunderstanding of siphons is that they rely on the tensile strength of the liquid to pull the liquid up and over the rise. While water has been found to have a great deal of tensile strength in some experiments such as with the z tube2. Furthermore, since common siphons operate at positive pressures throughout the siphon, there is no contribution from liquid tensile strength, because the molecules are actually repelling each other in order to resist the pressure, rather than pulling on each other. To demonstrate, the longer lower leg of a common siphon can be plugged at the bottom and filled almost to the crest with liquid as in Figure 5, leaving the top and the shorter upper leg completely dry and containing only air. When the plug is removed and the liquid in the longer lower leg is allowed to fall, the liquid in the upper reservoir will then typically sweep the air bubble down and out of the tube. The apparatus will then continue to operate as a normal siphon. As there is no contact between the liquid on either side of the siphon at the beginning of this experiment, there can be no cohesion between the liquid molecules to pull the liquid over the rise.