§170.207. Vocabulary standards for representing electronic health information. — Inbound Citations

(1) Vaccines Administered, July 30, 2009, IBR approved for § 170.207.

(12) Enable a user to record, change, and access a patient's family health history in accordance with the familial concepts or expressions included in, at a minimum, the version of the standard in § 170.207(a)(1).

(ii) At a minimum, the versions of the standards specified in § 170.207(a)(1) and (c)(1).

(i) At a minimum, the version of the standard specified in § 170.207(a)(4) or § 170.207(b)(2); or

(12) Enable a user to record, change, and access a patient's family health history in accordance with the familial concepts or expressions included in, at a minimum, the version of the standard in § 170.207(a)(1).

(i) At a minimum, the version of the standard specified in § 170.207(a)(4) or § 170.207(b)(2); or

(ii) For technology primarily developed to record dental procedures, the standard specified in § 170.207(b)(3).

(iii) The standard specified in § 170.207(b)(4).

(ii) At a minimum, the versions of the standards specified in § 170.207(a)(1) and (c)(1).

(ii) At a minimum, the versions of the standards specified in § 170.207(a)(1) and (c)(1).

(11) At a minimum, the standard specified in § 170.207(c)(3).

(ii) At a minimum, the versions of the standards specified in § 170.207(a)(1) and (c)(1).

(A) (1) For the time period up to and including December 31, 2027, enable a user to perform the prescription-related electronic transactions specified in paragraph (b)(3)(ii)(A)(3) of this section in accordance with the standards specified in § 170.205(b)(1) or (2).

(i) At a minimum, at least one of the versions of the standard adopted in § 170.207(d)(1).

(ii) The standard in § 170.207(d)(2) if using the standard in § 170.205(b)(2).

(2) On and after January 1, 2028, enable a user to perform the prescription-related electronic transactions specified in paragraph (b)(3)(ii)(A)(3) of this section in accordance with the standard specified in § 170.205(b)(2).

(i) At a minimum, at least one of the versions of the standard adopted in § 170.207(d)(1).

(ii) The standard in § 170.207(d)(2).

(3) The prescription-related electronic transactions are as follows:

(i) New prescriptions (NewRx).

(ii) Request and respond to change prescriptions (RxChangeRequest, RxChangeResponse).

(iii) Request and respond to cancel prescriptions (CancelRx, CancelRxResponse).

(iv) Request and respond to renew prescriptions (RxRenewalRequest, RxRenewalResponse).

(v) Receive fill status notifications (RxFill).

(vi) Request and receive medication history (RxHistoryRequest, RxHistoryResponse).

(vii) Relay acceptance of a transaction back to the sender (Status).

(viii) Respond that there was a problem with the transaction (Error).

(ix) Respond that a transaction requesting a return receipt has been received (Verify).

(x) Electronic prior authorization transactions (PAInitiationRequest, PAInitiationResponse, PARequest, PAResponse, PAAppealRequest, PAAppealResponse, PACancelRequest, PACancelResponse, and PANotification). These transactions are required if using the standard in § 170.205(b)(2).

(A) (1) For the time period up to and including December 31, 2027, enable a user to perform the prescription-related electronic transactions specified in paragraph (b)(3)(ii)(A)(3) of this section in accordance with the standards specified in § 170.205(b)(1) or (2).

(i) At a minimum, at least one of the versions of the standard adopted in § 170.207(d)(1).

(ii) The standard in § 170.207(d)(2) if using the standard in § 170.205(b)(2).

(2) On and after January 1, 2028, enable a user to perform the prescription-related electronic transactions specified in paragraph (b)(3)(ii)(A)(3) of this section in accordance with the standard specified in § 170.205(b)(2).

(i) At a minimum, at least one of the versions of the standard adopted in § 170.207(d)(1).

(ii) The standard in § 170.207(d)(2).

(3) The prescription-related electronic transactions are as follows:

(i) New prescriptions (NewRx).

(ii) Request and respond to change prescriptions (RxChangeRequest, RxChangeResponse).

(iii) Request and respond to cancel prescriptions (CancelRx, CancelRxResponse).

(iv) Request and respond to renew prescriptions (RxRenewalRequest, RxRenewalResponse).

(v) Receive fill status notifications (RxFill).

(vi) Request and receive medication history (RxHistoryRequest, RxHistoryResponse).

(vii) Relay acceptance of a transaction back to the sender (Status).

(viii) Respond that there was a problem with the transaction (Error).

(ix) Respond that a transaction requesting a return receipt has been received (Verify).

(x) Electronic prior authorization transactions (PAInitiationRequest, PAInitiationResponse, PARequest, PAResponse, PAAppealRequest, PAAppealResponse, PACancelRequest, PACancelResponse, and PANotification). These transactions are required if using the standard in § 170.205(b)(2).

(10) At a minimum, the standard specified in § 170.207(d)(3).

(D) Upon a user's confirmation, automatically update the list, and incorporate the following data expressed according to the specified standards:

(1) Medications. At a minimum, the version of the standard specified in § 170.213;

(2) Allergies and intolerance. At a minimum, the version of the standard specified in § 170.213; and

(3) Problems. At a minimum, the version of the standard specified in § 170.213.

(14) Vaccines Administered, updates through August 17, 2015, IBR approved for § 170.207(e).

(B) At a minimum, the version of the standard specified in § 170.207(e)(1) for historical vaccines.

(C) At a minimum, the version of the standard specified in § 170.207(e)(2) for administered vaccines.

(16) In accordance with, at a minimum, the standards specified in § 170.207(e)(3) and (4).

(B) At a minimum, the version of the standard specified in § 170.207(e)(1) for historical vaccines.

(16) In accordance with, at a minimum, the standards specified in § 170.207(e)(3) and (4).

(C) At a minimum, the version of the standard specified in § 170.207(e)(2) for administered vaccines.

(16) CDC Race and Ethnicity Code Set Version 1.0 (March 2000), IBR approved for § 170.207(f).

(i) The standard specified in § 170.207(f)(2); and

(A) (1) Enable each one of a patient's races to be recorded in accordance with, at a minimum, the standard specified in § 170.207(f)(3) and whether a patient declines to specify race.

(2) Enable each one of a patient's ethnicities to be recorded in accordance with, at a minimum, the standard specified in § 170.207(f)(3) and whether a patient declines to specify ethnicity.

(3) Aggregate each one of the patient's races and ethnicities recorded in accordance with paragraphs (a)(5)(i)(A)(1) and (2) of this section to the categories in the standard specified in § 170.207(f)(1).

(i) The standard specified in § 170.207(f)(2); and

(A) (1) Enable each one of a patient's races to be recorded in accordance with, at a minimum, the standard specified in § 170.207(f)(3) and whether a patient declines to specify race.

(2) Enable each one of a patient's ethnicities to be recorded in accordance with, at a minimum, the standard specified in § 170.207(f)(3) and whether a patient declines to specify ethnicity.

(3) Aggregate each one of the patient's races and ethnicities recorded in accordance with paragraphs (a)(5)(i)(A)(1) and (2) of this section to the categories in the standard specified in § 170.207(f)(1).

(A) (1) Enable each one of a patient's races to be recorded in accordance with, at a minimum, the standard specified in § 170.207(f)(3) and whether a patient declines to specify race.

(2) Enable each one of a patient's ethnicities to be recorded in accordance with, at a minimum, the standard specified in § 170.207(f)(3) and whether a patient declines to specify ethnicity.

(3) Aggregate each one of the patient's races and ethnicities recorded in accordance with paragraphs (a)(5)(i)(A)(1) and (2) of this section to the categories in the standard specified in § 170.207(f)(1).

(6) The standard specified in § 170.207(g)(2).

(B) Formatted according to at least one of the following standards:

(1) The standard specified in § 170.207(i).

(2) At a minimum, the version of the standard specified in § 170.207(a)(1).

(6) The Unified Code for Units of Measure, Version 2.1, November 21, 2017; IBR approved for § 170.207(m).

(ii) In accordance with the standard specified in § 170.207(c)(3) and with the associated applicable unit of measure for the vital sign measurement in the standard specified in § 170.207(m)(1).

(4) Depression must be coded in accordance with, at a minimum, the version of LOINC® codes specified in paragraph (c)(1) of this section and attributed with LOINC® codes 55757-9, 44250-9 (with LOINC® answer list ID LL361-7), 44255-8 (with LOINC® answer list ID LL361-7), and 55758-7 (with the answer coded with the associated applicable unit of measure in the standard specified in paragraph (m)(2) of this section).

(i) To provide clinical decision support;

(ii) To support physician order entry;

(iii) To capture and query information relevant to healthcare quality;

(iv) To exchange electronic health information with, and integrate such information from other sources; and

(C) Enable sex to be recorded in accordance with the standard specified in § 170.207(n)(1) for the period up to and including December 31, 2025; or § 170.207(n)(2).

(C) Enable sex to be recorded in accordance with the standard specified in § 170.207(n)(1) for the period up to and including December 31, 2025; or § 170.207(n)(2).

(F) Enable at least one sex parameter for clinical use to be recorded in accordance with, at a minimum, the version of the standard specified in § 170.207(n)(3). Conformance with this paragraph is required by January 1, 2026.

(D) Enable sexual orientation to be recorded in accordance with, at a minimum, the version of the standard specified in § 170.207(o)(1) for the period up to and including December 31, 2025; or § 170.207(o)(3), as well as whether a patient declines to specify sexual orientation.

(1) Sexual orientation must be coded in accordance with, at a minimum, the version of SNOMED-CT® U.S. Edition codes specified in paragraph (a)(4) of this section for paragraphs (o)(1)(i) through (iii) of this section and HL7 Version 3 Standard, Value Sets for AdministrativeGender and NullFlavor (incorporated by reference, see § 170.299), up until the adoption of this standard expires on January 1, 2026, for paragraphs (o)(1)(iv) through (vi) of this section, attributed as follows:

(i) 38628009

(ii) 20430005

(iii) 42035005

(iv) NullFlavor OTH

(v) NullFlavor UNK

(vi) NullFlavor ASKU

(1) Sexual orientation must be coded in accordance with, at a minimum, the version of SNOMED-CT® U.S. Edition codes specified in paragraph (a)(4) of this section for paragraphs (o)(1)(i) through (iii) of this section and HL7 Version 3 Standard, Value Sets for AdministrativeGender and NullFlavor (incorporated by reference, see § 170.299), up until the adoption of this standard expires on January 1, 2026, for paragraphs (o)(1)(iv) through (vi) of this section, attributed as follows:

(i) 38628009

(ii) 20430005

(iii) 42035005

(iv) NullFlavor OTH

(v) NullFlavor UNK

(vi) NullFlavor ASKU

(1) Sexual orientation must be coded in accordance with, at a minimum, the version of SNOMED-CT® U.S. Edition codes specified in paragraph (a)(4) of this section for paragraphs (o)(1)(i) through (iii) of this section and HL7 Version 3 Standard, Value Sets for AdministrativeGender and NullFlavor (incorporated by reference, see § 170.299), up until the adoption of this standard expires on January 1, 2026, for paragraphs (o)(1)(iv) through (vi) of this section, attributed as follows:

(i) 38628009

(ii) 20430005

(iii) 42035005

(iv) NullFlavor OTH

(v) NullFlavor UNK

(vi) NullFlavor ASKU

(1) Sexual orientation must be coded in accordance with, at a minimum, the version of SNOMED-CT® U.S. Edition codes specified in paragraph (a)(4) of this section for paragraphs (o)(1)(i) through (iii) of this section and HL7 Version 3 Standard, Value Sets for AdministrativeGender and NullFlavor (incorporated by reference, see § 170.299), up until the adoption of this standard expires on January 1, 2026, for paragraphs (o)(1)(iv) through (vi) of this section, attributed as follows:

(i) 38628009

(ii) 20430005

(iii) 42035005

(iv) NullFlavor OTH

(v) NullFlavor UNK

(vi) NullFlavor ASKU

(1) Sexual orientation must be coded in accordance with, at a minimum, the version of SNOMED-CT® U.S. Edition codes specified in paragraph (a)(4) of this section for paragraphs (o)(1)(i) through (iii) of this section and HL7 Version 3 Standard, Value Sets for AdministrativeGender and NullFlavor (incorporated by reference, see § 170.299), up until the adoption of this standard expires on January 1, 2026, for paragraphs (o)(1)(iv) through (vi) of this section, attributed as follows:

(i) 38628009

(ii) 20430005

(iii) 42035005

(iv) NullFlavor OTH

(v) NullFlavor UNK

(vi) NullFlavor ASKU

(1) Sexual orientation must be coded in accordance with, at a minimum, the version of SNOMED-CT® U.S. Edition codes specified in paragraph (a)(4) of this section for paragraphs (o)(1)(i) through (iii) of this section and HL7 Version 3 Standard, Value Sets for AdministrativeGender and NullFlavor (incorporated by reference, see § 170.299), up until the adoption of this standard expires on January 1, 2026, for paragraphs (o)(1)(iv) through (vi) of this section, attributed as follows:

(i) 38628009

(ii) 20430005

(iii) 42035005

(iv) NullFlavor OTH

(v) NullFlavor UNK

(vi) NullFlavor ASKU

(E) Enable gender identity to be recorded in accordance with, at a minimum, the version of the standard specified in § 170.207(o)(2) for the period up to and including December 31, 2025; or § 170.207(o)(3), as well as whether a patient declines to specify gender identity.

(2) Gender identity must be coded in accordance with, at a minimum, the version of SNOMED-CT® codes specified in paragraph (a)(4) of this section for paragraphs (o)(2)(i) through (v) of this section and HL7® Version 3 Standard, Value Sets for AdministrativeGender and NullFlavor (incorporated by reference in § 170.299), up until the adoption of this standard expires January 1, 2026, for paragraphs (o)(2)(vi) and (vii) of this section, attributed as follows:

(i) 446151000124109

(ii) 446141000124107

(iii) 407377005

(iv) 407376001

(v) 446131000124102

(vi) NullFlavor OTH

(vii) NullFlavor ASKU

(2) Gender identity must be coded in accordance with, at a minimum, the version of SNOMED-CT® codes specified in paragraph (a)(4) of this section for paragraphs (o)(2)(i) through (v) of this section and HL7® Version 3 Standard, Value Sets for AdministrativeGender and NullFlavor (incorporated by reference in § 170.299), up until the adoption of this standard expires January 1, 2026, for paragraphs (o)(2)(vi) and (vii) of this section, attributed as follows:

(i) 446151000124109

(ii) 446141000124107

(iii) 407377005

(iv) 407376001

(v) 446131000124102

(vi) NullFlavor OTH

(vii) NullFlavor ASKU

(2) Gender identity must be coded in accordance with, at a minimum, the version of SNOMED-CT® codes specified in paragraph (a)(4) of this section for paragraphs (o)(2)(i) through (v) of this section and HL7® Version 3 Standard, Value Sets for AdministrativeGender and NullFlavor (incorporated by reference in § 170.299), up until the adoption of this standard expires January 1, 2026, for paragraphs (o)(2)(vi) and (vii) of this section, attributed as follows:

(i) 446151000124109

(ii) 446141000124107

(iii) 407377005

(iv) 407376001

(v) 446131000124102

(vi) NullFlavor OTH

(vii) NullFlavor ASKU

(2) Gender identity must be coded in accordance with, at a minimum, the version of SNOMED-CT® codes specified in paragraph (a)(4) of this section for paragraphs (o)(2)(i) through (v) of this section and HL7® Version 3 Standard, Value Sets for AdministrativeGender and NullFlavor (incorporated by reference in § 170.299), up until the adoption of this standard expires January 1, 2026, for paragraphs (o)(2)(vi) and (vii) of this section, attributed as follows:

(i) 446151000124109

(ii) 446141000124107

(iii) 407377005

(iv) 407376001

(v) 446131000124102

(vi) NullFlavor OTH

(vii) NullFlavor ASKU

(2) Gender identity must be coded in accordance with, at a minimum, the version of SNOMED-CT® codes specified in paragraph (a)(4) of this section for paragraphs (o)(2)(i) through (v) of this section and HL7® Version 3 Standard, Value Sets for AdministrativeGender and NullFlavor (incorporated by reference in § 170.299), up until the adoption of this standard expires January 1, 2026, for paragraphs (o)(2)(vi) and (vii) of this section, attributed as follows:

(i) 446151000124109

(ii) 446141000124107

(iii) 407377005

(iv) 407376001

(v) 446131000124102

(vi) NullFlavor OTH

(vii) NullFlavor ASKU

(D) Enable sexual orientation to be recorded in accordance with, at a minimum, the version of the standard specified in § 170.207(o)(1) for the period up to and including December 31, 2025; or § 170.207(o)(3), as well as whether a patient declines to specify sexual orientation.

(H) Enable at least one pronoun to be recorded in accordance with, at a minimum, the version of the standard specified in § 170.207(o)(4). Conformance with this paragraph is required by January 1, 2026.

(i) Enable financial resource strain to be recorded in accordance with the standard specified in § 170.207(p)(1) and whether a patient declines to specify financial resource strain.

(ii) Enable education to be recorded in accordance with the standard specified in § 170.207(p)(2) and whether a patient declines to specify education.

(iii) Enable stress to be recorded in accordance with the standard specified in § 170.207(p)(3) and whether a patient declines to specify stress.

(iv) Enable depression to be recorded in accordance with the standard specified in § 170.207(p)(4) and whether a patient declines to specify depression.

(v) Enable physical activity to be recorded in accordance with the standard specified in § 170.207(p)(5) and whether a patient declines to specify physical activity.

(vi) Enable alcohol use to be recorded in accordance with the standard specified in § 170.207(p)(6) and whether a patient declines to specify alcohol use.

(vii) Enable social connection and isolation to be recorded in accordance the standard specified in § 170.207(p)(7) and whether a patient declines to specify social connection and isolation.

(viii) Enable exposure to violence (intimate partner violence) to be recorded in accordance with the standard specified in § 170.207(p)(8) and whether a patient declines to specify exposure to violence (intimate partner violence).

(1) [Reserved]

(G) First name, last name, previous name, middle name (including middle initial), suffix, date of birth, current address, phone number, and sex. The following constraints apply:

(1) Date of birth constraint. (i) The year, month and day of birth must be present for a date of birth. The technology must include a null value when the date of birth is unknown.

(ii) Optional. When the hour, minute, and second are associated with a date of birth the technology must demonstrate that the correct time zone offset is included.

(2) Phone number constraint. Represent phone number (home, business, cell) in accordance with the standards adopted in § 170.207(q)(1). All phone numbers must be included when multiple phone numbers are present.

(3) Sex Constraint: Represent sex with the standard adopted in § 170.207(n)(1) up to and including December 31, 2025; or with the standard adopted in § 170.207(n)(2).

(3) Medicare Provider/Supplier to Healthcare Provider Taxonomy, April 2, 2015, IBR approved for § 170.207(r).

(C) Provider type in accordance with, at a minimum, the standard specified in § 170.207(r)(2).

(C) Provider type in accordance with, at a minimum, the standard specified in § 170.207(r)(2).

(1) OpenID Connect Core 1.0 Incorporating errata set 1, November 8, 2014, IBR approved for § 170.215(b).

(E) Patient insurance in accordance with the standard specified in § 170.207(s)(2).

(E) Patient insurance in accordance with the standard specified in § 170.207(s)(2).