Installation and Maintenance of Health IT Systems
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Transcript of Installation and Maintenance of Health IT Systems
This material Comp8_Unit2 was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.
Installation and Maintenance of Health IT Systems
System Selection – Software and Certification
System Selection – Software and Certification
Learning Objectives
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Installation and Maintenance of Health IT SystemsSystem Selection – Software and Certification
1. Compare and contrast COTS (Commercial Off-The-Shelf) and In-House /homegrown systems and describe their relative advantages and disadvantages
2. Verify system compliance with ONC-ATCB certification
3. Identify purpose and categories of ARRA “Meaningful Use” criteria
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Off-the-Shelf Software
• Commercial Off-the-Shelf (COTS)
• Modifiable Off-the-Shelf (MOTS)
• 200+ companies claim to make an EHR (Electronic Health Record)
• May include “freeware” with commercial support
Installation and Maintenance of Health IT SystemsSystem Selection – Software and Certification
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Advantages of COTS
• Lower development costs
• Wider “test market” to find bugs and limitations
• Vendor training and product support, bug fixes
• Easier learning curve
• Eliminate development time
Installation and Maintenance of Health IT SystemsSystem Selection – Software and Certification
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Disadvantages of COTS
• Unalterable source code
• Compatibility issues
• Uncertain upgrade schedules
• Business practices may have to be modified, and workflow often has to be adapted to the particular product design.
(Rice, 2009)
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In-House / Homegrown
• Locally-installed and managed EHR implementation
• Only available to institutions with existing IT infrastructure and investment
• Developed by – extending existing In-House systems, or– adapting open-source or other publically
available software for institution needs
Installation and Maintenance of Health IT SystemsSystem Selection – Software and Certification
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Advantages of In-House
• Developed wholly by the operating institution
• Design is specifically tailored to meet institutional objectives
• Can mesh comfortably with existing workflow processes
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Installation and Maintenance of Health IT SystemsSystem Selection – Software and Certification
Disadvantages of In-House
• Higher development costs, initial and throughout product lifecycle
• Dependent on expertise of in-house development staff
• Lack of vendor support – bug fixes, upgrades
• Training must be developed in-house.
• Longer development time
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Installation and Maintenance of Health IT SystemsSystem Selection – Software and Certification
EHR Certification
• Office of the National Coordinator for Health Information Technology (ONC) provides for a certification program for EHR Technology
– Temporary Certification Program in effect June 2010– Permanent Certification Program in January 2011, replacing temporary program in
2012• American National Standards Institute (ANSI) is the ONC-Approved
Accreditor (AA) for the Permanent Certification Program – ANSI will certify the ATCBs
– Only 6 ATCBs as of Dec. 2011 (http://healthIT.hhs.gov/ATCBs)• ATCBs are the Authorized Testing and Certification Bodies that grant
certification to the products and vendors of Complete EHRs and EHR Modules.
– Current list is available at http://onc-chpl.force.com/ehrcert • Certification is a prerequisite for participation in the Medicare and Medicaid
incentive programs, which provide payment to doctors, clinics, and hospitals that “demonstrate meaningful use of certified EHR technology”
(ONC, 2011; CMS 2011)
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Installation and Maintenance of Health IT SystemsSystem Selection – Software and Certification
Standards and Certifications Criteria Final Rule
• Final Rule on an initial set of standards, implementation specifications, and certification criteria adopted July 13, 2010– Interoperability, to work with systems sharing
information– Functionality, to perform a set of well-defined
functions– Security, to store and transmit confidentially and
reliably– Utility, to support meaningful use of HIT data
(SCCFR)
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Why Certification?
• Reduce risks to physicians in EHR investment
• Facilitate interoperability of EHR systems• Enhance availability of EHR adoption
through stimulus incentives• Ensure that EHR systems and networks
are secure and protect privacy
(Pizzi, 2007)
Installation and Maintenance of Health IT SystemsSystem Selection – Software and Certification
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Why Certification? (cont’d)
• Allow evaluation time to be used more efficiently
• Narrow the initial field of vendors
• Assure basic functionality and interoperability, allowing you to focus evaluation more on special or unusual needs of your institution
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What are ARRA and “Meaningful Use”?
• ARRA (American Recovery and Reinvestment Act, a.k.a. “stimulus bill”) – Passed by Congress February 2009– Over $22 billion allocated to modernize health IT
system.– HITECH (Health Information Technology for
Economic and Clinical Health) Act: initially rewards institutions for “meaningful use” of EHRs, then in 2015 imposes penalties.
(Hitechanswers)
Installation and Maintenance of Health IT SystemsSystem Selection – Software and Certification
(Recovery.org, 2009)
(cms.gov, 2011)
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Meaningful Use Criteria: Stage 1
• According to Centers for Medicare & Medicaid Services (CMS), the priorities for hospitals & providers are to:1. Improve quality, safety, and efficiency, and reduce
health disparities2. Engage patients and families in their health care3. Improve care coordination4. Improve population and public health5. Ensure adequate privacy and security protections
for personal health information
(CMS, 2011)
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Meaningful Use Criteria: Stage 1 (cont’d)
1. Improve quality, safety, and efficiency, and reduce health disparities
– Computerized Provider Order Entry (CPOE, directly entered by authorizing provider) for 10+% of all orders
– Drug-drug, drug-allergy, drug-formulary checks– Up-to-date problem list of current and active
diagnoses, based on ICD-9 or SNOMED vocabularies
– Active medication list– Active medication allergy list
(CMS, 2011)
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Meaningful Use Criteria: Stage 1 (cont’d)
1. Improve quality, safety, and efficiency, and reduce health disparities (cont'd)
– Demographics• Preferred language, insurance type, gender, race,
ethnicity, date of birth, date and cause of death
– Vital signs• Changes in height, weight, blood pressure; calculate
and display Body Mass Index (BMI); plot and display growth charts, including BMI, for children 2-20 years
(CMS, 2011)
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Meaningful Use Criteria: Stage 1 (cont’d)
1. Improve quality, safety, and efficiency, and reduce health disparities (cont'd) –Smoking status (13+ years old)–Laboratory test results as structured data–Lists of patients by specific conditions–Report quality measures to CMS or states–Five clinical decision support rules, including for diagnostic test ordering, along with ability to track compliance–Submit claims electronically, public and private
(CMS, 2011)
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Meaningful Use Criteria: Stage 1 (cont’d)
2. Engage patients and families in their health care
– Provide patients with electronic copy of health information upon request
• Diagnostic test results, problem list, medication lists, allergies, discharge summary, procedures
• Discharge instructions at the time of discharge
(CMS, 2011)
Installation and Maintenance of Health IT SystemsSystem Selection – Software and Certification
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Meaningful Use Criteria: Stage 1 (cont’d)
3. Improve care coordination– Electronically exchange key clinical
information– Medication reconciliation at relevant
encounters and each transition of care– Summary of care record for each transition of
care and referral
(CMS, 2011)
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Meaningful Use Criteria: Stage 1 (cont’d)
4. Improve population and public health– Capability to:
• Submit data to immunization registries• Submit data on reportable lab results (as required
by state or local law) to public health agencies• Provide electronic syndromic surveillance data to
public health agencies
– Actual data submissions under certain circumstances
(CMS, 2011)
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Meaningful Use Criteria: Stage 1 (cont’d)
5. Ensure adequate privacy and security protections for personal health information
– Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.
(CMS, 2011)
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Meaningful Use Criteria: Next Stages
• Projected timeline of implementation– Stage 2: 2013– Stage 3: 2015
• Requirements– Not yet officially defined– Expected to require taking stage 1 functions
even further; e.g., increasing e-prescribing from 40% to 50% (stage 2) and then to 80% (stage 3)
(Federal Register, 2011)
Installation and Maintenance of Health IT SystemsSystem Selection – Software and Certification
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Typical EHR Costs to Consider
• Start up costs– Initial hardware and network upgrades– Initial software and licensing– Initial interfaces
• Maintenance costs– Annual software licensing, upgrades, support– Annual interface upgrades and support
Installation and Maintenance of Health IT SystemsSystem Selection – Software and Certification
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Typical EHR Costs to Consider (cont'd)
• Training costs– Administrators– Users
• Productivity costs– Lost during transition
• Consultant fees
Installation and Maintenance of Health IT SystemsSystem Selection – Software and Certification
System Selection – Software and Certification
Summary
• COTS advantages and disadvantages weighed against in-house advantages and disadvantages
• Costs involved in startup and maintenance of the system should be addressed
• Certified systems and modules are preferred
• Meaningful use priorities should be addressed
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System Selection – Software and CertificationReferencesReferences
• About ARRA. Retrieved from HITECH Answers website: http://www.hitechanswers.net/about/about-arra/• ARRA Meaningful Use Snapshot. (n.d.). Retrieved from Medical Information Technology, Inc. website:
http://www.meditech.com/interoperability/pages/ARRA_snapshot_final_0311.pdf • Certified Health IT Product List. Retrieved from Office of the National Coordinator for Health Information
Technology, US Department of Health & Human Services website: http://onc-chpl.force.com/ehrcert • Electronic Medical Record [cited 2010 June 20]. Retrieved from:
http://en.wikipedia.org/wiki/Meaningful_Use#Meaningful_Use • EHR Incentive Programs Overview. (n.d.). Retrieved from Centers for Medicare & Medicaid Services website:
https://www.cms.gov/EHRIncentivePrograms/ • Medicare and Medicaid Programs; Electronic Health Record Incentive Program (2010, July). Federal Register.
[Internet]. Retrieved from http://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-program .
• Fornes, D. (2008, February 6). Should CCHIT Influence Your EHR Selection? [Web log post]. Retrieved from Software Advice - The Medical Blog: http://blog.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection
• Gates, M. (2009, Winter). All Systems Go? How to Select an EHR That Meets Your Needs. Correct Care, Retrieved from http://www.ncchc.org/pubs/CC/selecting_ehr.html
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System Selection – Software and Certification
References
Installation and Maintenance of Health IT SystemsSystem Selection – Software and Certification
References
• Goals for EHR System. Retrieved June 20, 2010, from Health Technology Review website: http://www.healthtechnologyreview.com/viewarticle.php?aid=113 • HITECH Act Enforcement Interim Final Rule. (n.d.). Retrieved from U.S. Department of Health & Human Services website: http://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcementrule/hitechenforcementifr.html • McKinney, D. (2001, August). Impact of Commercial Off-The-Shelf (COTS) Software and Technology on Systems Engineering. Retrieved from Presentation to INCOSE Chapters website:
http://www.incose.org/northstar/2001Slides/McKinney%20Charts.pdf • Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule, 75 Fed. Reg. 44314 (2010) 42 CFR Parts 412, 413, 422, and 495 http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf • ONC-Authorized Testing and Certification Bodies. Retrieved from Office of the National Coordinator for Health Information Technology, US Department of Health & Human Services website: http://healthIT.hhs.gov/ATCBs • Pizzi, R. (2007, October 30). EHR adoption an "ugly process," but CCHIT can improve appeal. Retrieved from Healthcare IT News website: : http://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-
improve-appeal • Rice, R. (2009). Testing COTS-Based Applications . Retrieved June 21, 2010, from http://www.riceconsulting.com/articles/testing-COTS-based-applications.htm
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System Selection – Software and Certification
References
Installation and Maintenance of Health IT SystemsSystem Selection – Software and Certification
References
Standards & Certification. Retrieved from Office of the National Coordinator for Health Information Technology, US Department of Health & Human Services website: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__standards_and_certification/1153
Standards & Certification Criteria Final Rule. Retrieved from Office of the National Coordinator for Health Information Technology, US Department of Health & Human Services website: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__standards_ifr/1195
Images
Slide 13: ARRA recovery.gov logo http://www.recovery.gov/News/mediakit/Picture%20Library/circle_recovery_logo.jpg
Slide 13: Center for Medicare and Medicaid Services EHR Incentive Programs logo http://www.cms.gov/EHRIncentivePrograms/Downloads/EHRIncentiveLogoweb.JPG