The Source for Healthcare Information EHR–System Developing a Functional Model and Standard HIMSS...

The Source for Healthcare Information

EHR–SystemDeveloping a Functional Model

and StandardHIMSS Audio Conferences

August 7 and 14, 2003


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Outline

• History

• Charter

• HL7 and IOM Roles and Deliverables

• HL7 EHR-S Model and Standard

• IOM EHR-S “Key Capabilities” Report

• HL7 Balloting Process

• HIMSS Role and Member Call to Action


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History

• Health and Human Services (HHS) and CMS want to pilot “pay for performance”– Provide financial incentives for better quality care.– How to measure quality?

• Focused on use of EHR System to– Accelerate rate of adoption of clinical systems to achieve

better quality at lower cost.– Support adoption of message and content standards for

secure and private transmission of medical information.– Provide for consumer use of interconnected health

systems.


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Charter

• Call to Action: HHS Secretary Tommy Thompson Announcement – @ NHII on 7/1/03– HHS has licensed SNOMED medical vocabulary and

made available for free to providers.

– Enlisted Institute of Medicine and HL7 to develop a functional model for a standardized electronic health record.

– http://www.hhs.gov/news/press/2003pres/20030701.html


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HL7 and IOM Roles and Deliverables

• CMS and Veterans Health Administration approached HL7 and its EHR Special Interest Group (SIG) at spring HL7 meeting.

• Asked them to meet challenging goal of an ANSI balloted EHR System (EHR-S) Functional Model and Standard by January 2004.

• HL7 EHR SIG directed to create EHR-S Functional Model and Standard.

• IOM directed to provide EHR-S Functional Needs and Priority by Care Settings.


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HL7 EHR System Functional Model and Standard

• Scope and Definition• Framework• Content

– Functional triplets– Care Setting Profiles– User Profiles

• Tools– Hierarchy– Submittal Forms


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HL7 EHR-S Scope and Definition

• Discovery uncovered definitions of EHR and EHR-S from many standards groups including IOM, ISO, ASTM and HIMSS.

• Did not define the EHR but accepted the concept of the EHR-S as a set of functions for primary and secondary users.

• Note that it is a “System” not just an EHR.– CMS wants advanced functions such as CPOE with

decision support not just access to a record in electronic form.


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HL7 EHR-S Framework


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HL7 EHR-S Framework


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HL7 EHR Functional Triplets

• Function– Example drug-to-drug checking

• Rationale for Use– Prevent adverse drug event through interaction.

• Conformance Criteria– If a drug is ordered that interacts with currently

prescribed drug, system notifies user.


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The HL7 EHR-S Functional Groupings

• Direct Care Health Information• Work Flow and Operations Management• Communications• Records, Documents and Views• Clinical Support• Measurement, Analysis, Research and Reports• Administrative, Finance


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IOM Letter Report

• “Key Capabilities of an Electronic Health Record System” – July 31, 2003– at http://books.nap.edu/html/ehr/NI000427.pdf

• Prepared by the Committee on Data Standards for Patient Safety

• Defines core functionality of EHR-S in four care settings– Hospital, ambulatory, nursing home, and care in the

community (personal health)– Sets time frame (2004-5, 2006-7 and 2008-10)


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The IOM’s Definition of an EHR-S

Includes:1) longitudinal collection electronic health information for

and about persons, where health information is defined as information pertaining to the health of an individual or health care provided to an individual

2) immediate electronic access to person- and population-level information by authorized, and only authorized, users;

3) provision of knowledge and decision-support that enhance the quality, safety, and efficiency of patient care;

4) support of efficient processes for health care delivery.


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Primary and Secondary Uses of an Electronic Health Record System

Adapted from Institute of Medicine (1997)

Primary Uses• Patient Care Delivery • Patient Care Management• Patient Care Support Processes • Financial and Other Administrative Processes• Patient Self-Management

Secondary Uses • Education • Regulation • Research • Public Health and Homeland Security• Policy Support


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IOM’s Core Functionalities for an Electronic Health Record System

• Health information and data• Results management• Order entry / management• Decision support• Electronic communication and connectivity• Patient support• Administrative processes• Reporting & population health management


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IOM EHR Capabilities

CORE FUNCTIONALITIES

CARE SETTING REQUIREMENTS AND TIME FRAME

Hospitals Outpatients Nursing homes

Care in the community

Health information and data

Results management

Order entry/management

Decision support

Electronic communication and connectivity

Patient support

Administrative processes

Reporting and population health management

High Level Abstraction


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The HL7 Ballot Process

• ANSI accredited Standards Developer Organization

• Participation in balloting by any interested party– Does require a $100 administrative fee if not a HL7

member

• Open meetings to develop consensus and reconcile negatives– Also requires meeting registration fee

• Draft Standard for Trial Use– Requires 2/3 affirmative vote to pass


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Status of the Draft Ballot

• Ballot available August 7th

• Ballot closes on September 6th

• Available on HL7 web site – www.hl7.org/ehr

• Ballot reconciliation at HL7 Plenary and Working Group Meetings In Memphis– Full meetings September 7 – 12– EHR SIG September 9 – 11– Must register at www.hl7.org


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HIMSS Role

• HIMSS has strongly supported a universal EHR and applauds this effort– Submitted its Definitional Model – June 2003

– Funded HL7 EHR Standard effort (subject matter experts)

– Member of EHR Collaborative to promote industry participation in EHR-S standardization process

– Will draft a response to the Ballot by August 15 for comment by members


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HIMSS Call to Action

• Standards development is an inclusive process.– Standards rarely pass on first ballots, but

• This is a major opportunity for the healthcare and the HCIT industry.– We want to be part of the ongoing dialogue and

solution.

– We also want to insure that whatever standard CMS adopts has gone through a open consensus process.

• Use HIMSS resources and participate!


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Contacts

• Charlene UnderwoodSiemens/ [email protected]

• Pat WiseHIMSS/ [email protected]

• Ed LarsenE. R. Larsen, Inc./ [email protected]

• Joyce SensmeierHIMSS/ [email protected]

The Source for Healthcare Information EHR–System Developing a Functional Model and Standard HIMSS...

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