Capability Types of Costs or Fees to be paid by the Provider for the Capability Limitations (Contractual / Business Practices) Limitations (Technical / Practical)
Cloud-based solution with an EHR Subscription Agreement A recurring (monthly) license fee per provider, per month. This fee includes the cost of hosting, support, regular product enhancements and monthly maintenance. The software is offered in the SaaS model (Software as a Service) and data is hosted by ezEMRx .  Implementation fees, such as travel and airfare costs, and training fees are billed separately. Support and maintenance may require a one-time setup cost and/or recurring costs. A contractual agreement is required, as well as acceptance of terms and conditions. All providers must have an active license to use the software.
RCM with a cloud-based EHR Agreement RCM contract includes a percentage of the total collected revenue and additional, optional fees, such as fees for patient statements, clearing house fees, credentialing fees, eligibility fees and dictionary subscription fees. Implementation fees, such as travel and airfare costs, and training fees are billed separately. A contractual agreement is required and the terms and conditions have to be accepted. All providers must have an active license to use the software.
iPad-based EHR add-on Providers will require a cloud-based EHR subscription to use this add-on. There is no additional cost for this capability. None An add-on app that leverages the Apple® iPad® technology to give customers the look, feel, and functionality that they expect, coupled with the ease-of-use found with an iPad. This app is intended primarily for our mid-office users and combines the most used features that a doctor, mid-level nurse, etc. would utilize to complete the  patient’s Progress Notes documentation.
170.315(a)(1) Computerized Provider Order Entry - Medications None None Electronic prescriptions are routed to pharmacies via Surescripts (http://www.surescripts.com) using the NewCorp backend processing engine.
170.315(a)(2) Computerized Provider Order Entry - Laboratory Nones are required to use this functionality. If the practice chooses to integrate with a third-party laboratory via HL7, then additional costs may be associated to set up the interface. Interfaces that benefit a larger group of providers are available at no cost. A professional services agreement is required to set up an interface. Supported versions of HL7 are  2.3, 2.5.1
170.315(a)(3) Computerized Provider Order Entry – Diagnostic Imaging None is required to use this functionality. If the practice chooses to integrate with a third-party laboratory via HL7, then additional costs may be associated to setup the interface. Interfaces that benefit a larger group of providers are avaliable at no cost. A professional services agreement is required to set up an interface. Supported versions of HL7 are  2.3, 2.5.1
170.315(a)(4) - Drug-Drug, Drug-Allergy Interaction Checks Providers will require a cloud-based EHR subscription. There is no additional cost for this capability. None ezEMRx uses the First DataBank (FDB) medication dictionary. Dictionary updates happen regularly or whenever the update is made available via our web services. If a user captures an uncoded medication / allergy or problems, then Drug-drug, Drug-allergies and Drug-problems will not be listed. 
170.315(a)(5) Demographics None None None
170.315(a)(9) Clinical Decision Support None None ezEMRx uses the Medline Plus web services to publish patient education materials, and PubMed for clinical references. If these services are down, users might experience issues.
170.315(a)(10) Drug Formulary and Preferred Drug List None None Drug formulary information is sourced from Surescripts (http://www.surescripts.com) and availability is dependent on the patient's eligibility status with the payer. To obtain a response and ensure accuracy, the appropriate PBM Insurance for the patient must be selected and the payer must support electronic eligibility verification.
170.315(a)(12) Family Health History None None None
170.315(a)(13)
Patient-Specific Education Resources
Providers will require a cloud-based EHR subscription. There is no additional cost for this capability. None ezEMRx provides patient-specific education resources in the form of patient information orders throughout the ordering workflow. These orders contain links to handouts with content sourced from MedLinePlus, which a provider can either print or publish on the patient portal.
The InfoButton Standard is used to recommend information by enabling the Patient Education Information link in the Plan section of the encounter.  When the Publish button is clicked, the content is published on the patient portal.
170.315(a)(14) Implantable Device List None None Unique Device Identifiers (UDIs) can be entered by scanning the device label using a barcode scanner. Two-line barcode scanners are not supported. If barcode scanning is not utilized, the UDIs need to be entered manually. Device attributes are retrieved from the FDA's Global Unique Device Identification Database (GUDID - https://accessgudid.nlm.nih.gov/) in real time. Information will only be displayed if the data exists and it can be retrieved from GUDID.
170.315(a)(15) Social, Psychological, and Behavioral Data None None None
170.315(b)(1) Transitions of Care None None None
170.315(b)(2) - Clinical Information Reconciliation and Incorporation None None None
170.315(b)(3) - Electronic Prescribing Providers will require a cloud-based EHR subscription. There is no additional cost for this capability. Providers must enter into an agreement with SureScripts and receive an SPI in order to begin e-prescribing. Electronic prescriptions are routed to pharmacies via Surescripts, using the NewCorp backend processing engine.
170.315(b)(7) Data Segmentation for Privacy - send None None User can mark any relevant text as "Confidential", while submitting the encounter notes. When transmitting such CCDA, the system will include the Data segmentation section with the XML.
170.315(b)(8) Data Segmentation for Privacy - receive None None None
170.315(b)(9) Care Plan None None None
170.315(c)(1-3) - Clinical Quality Measures - Record and export, Import and calculate, and Report. None None The system runs a CQM engine every night and updates the Numerator/Denominator across all providers. The system will take time to reflect the Numerator/Denominator (Exclusion etc.) based on the number of active providers. The customer needs to coordinate with the ezEMRx support staff to schedule an export of the QRDA I details.
170.315(d)(1) - Authentication, Access Control, Authorization None None None
170.315(d)(2) - Auditable Events and Tamper- resistance None None Users do not have the ability to disable the logging of auditable events. Print action events will only be recorded when a print link is embedded in the software, based on the client's request. If there is no print link embedded in the software, printing via the web browser will be logged as user "access," even if the user prints the web page.
170.315(d)(3) - Audit Reports None None None
170.315(d)(4) - Amendments None None None
170.315(d)(5) Automatic Access Time-Out None None All ezEMRx users are subject to a default access time-out. End users will not have access to modify the default time-out settings.
170.315(d)(6) - Emergency Access None None System admins within the practice will have the option to identify users who have the break the glass features.
170.315(d)(7) - End-user Device Encryption None None None
170.315(d)(8) - Integrity None None None
170.315(d)(9) - Trusted Connection None None ezEMRx current certification, application access, Secure Messaging (170.315(e)(2)) and Application Access - Patient Selection (170.314(g)(7)) utilize AES-128 or better for encryption and SHA-2 for signatures.
170.315(d)(10) Auditing actions on health information None None Users do not have the ability to disable logging of auditable events.
170.315(e)(1) View, Download, and Transmit to Third Party (VDT) None None System admins will have the option to configure within the practice setup, the level of access that can be provided to the patient.
170.315(e)(2) - Secure Messaging None None System admin will have an option to enable the users, who can receive secure message directly from the patient  or patient-authorized representatives.
170.315(e)(3) - Patient Health Information Capture None None Patient-provided health data (e.g., Health History forms, medication/allergies and social history, which includes tobacco use, etc ) submitted through the patient portal by patients or authorized representatives must be reviewed and approved by clinicians prior to being applied to the patient's health record.
170.315(f)(1) - Transmission to Immunization
Registries
None Customers are required to obtain the credentials for electronic submission of Immunization records from state registries The mother's name is mandatory for patients who are children, when transmitting the records to the registry.
170.315(f)(2) - Transmission to Public Health Agencies - Syndromic Surveillance None ezEMRx will interface with the respective state registries to identify the value sets that need to be made available in the transmission. None
170.315(f)-(5) - Transmission to Public Health Agencies – Electronic Case Reporting None ezEMRx will interface with the respective state registries to identify the value sets that need to be made available in the transmission. None
170.315(g)(2) - Automated Measure Calculation None None None
§170.315(g)(3) - Safety-enhanced Design (SED) None None None
170.315(g)(4) - Quality Management System None None None
170.315(g)(6) - Consolidated CDA Creation Performance None None Medical Allergies: ezEMRx utilizes the First Databank (FDB) medication dictionary and its associated mappings against RxNorm. If there is no match for an FDB code that may have been discontinued, the RxNorm code will not be associated. If a medication allergy has multiple ingredients, all the ingredient-level RxCUIs will be associated.

Medication : ezEMRx utilizes the FDB medication dictionary and its associated mappings against RxNorm. If there is no match for an FDB code that may have been discontinued, the RxNorm code will not be associated.

Problems: The system will display the SNOMED mappings to ICD10 and the user has to map the relevant SNOMED codes to the problem list. If the user does not map the SNOMED codes, the problems will be transmitted as ICD10 codes.
Vitals units of measure:
a. Height: Inches [in_i]
b. Weight: Pounds [lb_av]
c. Blood Pressure (Diastolic): [Hg]
d. Blood Pressure (Systolic): [Hg]
e. Heart Rate: /min
f. O2% BldC Oximetry: %
g. Inhaled Oxygen Concentration: (FIO2) %
h. Body Temperature: Fahrenheit [degF]
i. Respiratory Rate: /min
Smoking Status: Sent as a SNOMED code.
Encounter Diagnosis: Sent as a SNOMED code.
Immunizations: Sent as CVX.
Laboratory Test: Sent as LOINC codes.
Laboratory Results: Sent as LOINC codes. Completed orders must be marked as Received.
UDI: Device code is sent.
Care Team: Includes all providers who met the patient during a particular visit
Assessment and Plan of Treatment: Includes the data captured within the Assessment and Plan of Treatment.
Plan of Treatment – Future/pending orders. (Lab/DI/Procedures): Medications prescribed, follow-up visits scheduled, and Treatment notes.
Goals: Structured data that is set up and mapped by the user.
Health Concerns: Structured data that is set up and mapped by the user.
Reason for referral: Information specified in the Reason section of a referral.
Functional Status: Structured data that is set up and mapped by the user.
Cognitive Status: Structured data that is set up and mapped by user.
170.315(g)(7-9) - Application Access: Patient Selection, Data Category Request, All Data Request Providers will require a cloud-based EHR subscription. There is no additional cost for this capability. A contractual agreement is required, as well as acceptance of terms and conditions. This product is to be used for patient's benefit, not for personal or business gain. Third-party application developers must use the FHIR DSTU3 standards that are published on the website. Terms of use are specified within the contract, # of API calls of vendor, per patient, restriction on calls made from unknown sites, calls made, blacklist apps and IPs.

To access the APIs, users need to register with ezEMRx FHIR.
170.315(h)(1) - Direct Project Providers will require a cloud-based EHR subscription. There is no additional cost for this capability. None In order to successfully process an inbound or outbound message, the vendor, HISPTrust Anchor, must be bound to the domains supported by ezEMRx HISP. For outbound messages, a valid clinical summary document conforming to the C-CDA format must be attached to the message. DIRECT messaging is routed using the SES backend processing engine.