Please note: This post by the HIT Standards Committee’s Implementation Workgroup is now closed for comment. Monitor this blog for more posts from the FACA committees and its workgroups as issues develop. Also, please visit the Health IT Buzz Blog to join other Health IT related conversations.
Today, the Health IT Standards Committee within the Department of Health and Human Services will begin an unprecedented effort to get the public’s view on how our work might “pull forward” the benefits of healthcare information technology (IT). Specifically, we’re interested in uncovering new strategies to accelerate the adoption of health IT standards. This effort began with the passage of the American Recovery and Reinvestment Act of 2009, calling for recommendations on standards to promote safe, secure, healthcare information exchange.
“Standards” are really the guardians of quality, consistency, and interoperability. Without thoughtful, clear and uniform standards, we cannot enable the seamless and secure exchange of electronic health information (or the benefits that accrue to providers and patients from such protected exchanges).
So, while the exploration of technical standards may seem mundane to some, it is foundational to electronic health records (EHRs) and electronic health information exchange more broadly. In other words, it’s worth paying some attention to, and voicing your opinions.
Our process continues with a public hearing today in Washington, DC, accessible via phone and webcast at http://healthit.hhs.gov/portal/server.pt. We are convening four panels of experts with on-the-ground experience in interoperability standards – providers, quality stakeholders, health IT vendors, and a group with lessons drawn outside of healthcare. Thanks to HIT Standards Committee member Judy Murphy for her leadership on this effort.
The public hearing draws to a close this afternoon but we will continue the conversation through an Online Forum over the next two weeks. Thanks to Committee Member Cris Ross for his leadership on this effort. Given the breadth of interests, we have arranged a series of Committee Member blog posts to begin the dialogue, starting with HIT Standards Committee Vice-Chair John Halamka’s summary of our work to date, which will post on Friday. We will concurrently enable ongoing discussion threads on the following topics:
1) Proposed Standards (General Discussion)
2) Interoperability
3) Vocabularies
4) Privacy
5) Security
6) Quality
7) Implementation Case Studies (Your Story – the good, bad and in-between)
We have also enabled a “voting” feature on submissions to allow you – the public – an opportunity to emphasize points raised in a given post. Our goal is to harness the shared wisdom of our community to inform the work of the HIT Standards Committee in the weeks and months ahead.
The tight schedule of this process is designed to ensure that your ideas inform the HIT Standards Committee at its November 19th meeting. However, your ongoing feedback on our efforts is also encouraged via written submission or public comment at any of the subsequent monthly meetings of the HIT Standards Committee.
The process of accelerating the adoption of health IT standards will not end this week, this month, or this year. This is an ongoing effort, and your participation will continue to be essential to its success.
– Aneesh Chopra, U.S. Chief Technology Officer
Tags: FACA, Federal Advisory Committee Act, health IT, HIT Standards Committee
Many people believe the future of healthcare will involve a primary-care medical-home which is connected electronically to other low-cost specialty providers. The system will work to keep patients healthy and keep them out of high-cost emergency rooms and inpatient settings. Thus the future of healthcare will center on digitally connected doctors’ offices rather than large hospitals.
Despite this, current HIT programs seem biased against independent physician practices. This month a large hospital system announced it would pay for EMR software for all its affiliated providers. This type of EMR subsidy raises the question of capturing referrals through the “electronic acquisition” of the independent physician practices.
To avoid the appearance of impropriety, I would recommend that any hospital-provided EMR deal should include these provisions: 1) The EMR offer should be not be limited to providers with a hospital affiliation; 2) Accepting the EMR deal should not obligate the provider to accept or maintain a hospital affiliation; 3) The data generated in the provider’s office should be stored at the provider’s office or by an independent party; and 4) The provider should be able to exit the deal without unreasonable costs or penalties, and with the ability to keep the EMR or transfer to a new EMR.
Moreover, I would suggest that each EMR vendor provide a way to directly (through the EMR vendor aggregation gateway) connect its independent provider-clients to the RHIO or NHIN. This would allow a provider to remain independent of the large hospital systems.
Agree or Disagree:
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6 (+7)
Interoperability:
We have been working with the Oregon HITOC (http://www.oregon.gov/OHPPR/HITOC/index.shtml) to assist in development of a state-wide health information exchange (HIE) while also working to create a local HIE (Gorge Health Connect). Climbing over some barriers has proven challenging. Probably the most difficult is overcoming resistance from stakeholders who seem to fear losing control of the data. Of course, the data should rightfully be controlled by the patient, but if that data is held in disparate silos, then organizations sometimes wall the data in making it difficult to access and share.
Locally we have been able to get significant buy in from area providers and I believe we will make excellent progress in the next year in the development of Gorge Health Connect. Mid Columbia Medical Center, La Clinica del Carino Family
Health Care Center and North Central Oregon Public Health sponsored discussions to create Gorge Health Connect serving The Dalles, Oregon and surrounding area. Participating organization include Columbia River Women’s Clinic. Mid Columbia Surgical Specialists, Arlington Clinic, Moro Clinic and Deschutes Rim Clinic. The Consortium has submitted funding proposals to support further planning and HIE development.
At the state level there is incredible energy working to make plans for interoperability. The HITOC is taking the lead in this area, with plans now being developed to create a public/private partnership to create a non-profit Oregon eHealth Collaborative (OReHC) that will serve a convening and coordinating role. They will set the “rules of the road” for community and regional HIE operations while building on community collaboration and partnerships. OReHC would set policy and standards for statewide exchange, assuring compliance with the standards and policy from ONC. They would ensure that HIE is pursued in the public’s interest while operating with transparency and accountability.
A governance model is still being fleshed out and their are many exciting possibilities being discussed. The idea will be to set goals, objectives and performance measures for the exchange of relevant clinical data that reflects consensus among stakeholder groups and consumers. These goals, objectives and performance measures would need to provide statewide coverage of all providers for HIE requirements related to meaningful use criteria to be established by the Secretary through the rule-making process.
I believe Oregon is taking a thoughtful and measured approach to HIE that will avoid possible pitfalls from rushing in headlong without adequate preparation. There are some aggressive timelines and everyone is working very hard to cooperate so that we could be a model for how best to implement statewide HIE. I will provide updates on our progress as we respond to the shifting landscape and hopefully others can benefit from our failures and our successes.
Agree or Disagree:
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6 (+32)
I have been forced to use various CPOE and EMR equipment. The dangers are extensive and pervasive.
CPOE gear deployed in hospitals has caused mayhem that has resulted in patient death, all the while being blamed on the doctors who were forced to use the equipment.
That the ONC has not condsidered the abject dangers of CPOE devices is despicable and the failure to consider safety and efficacy as a component of meaningful use is folly.
There is dire need for the truth about these dangers to be known. It has been suggested that all users report their experiences in which patients were endangered, injured, or killed to the FDA at ist Medwatch tab.
Agree or Disagree:
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11 (+4)
We have had EMR for three years and there are occasional problems with it. But our main concern is that if our EMR doesn’t meet the “meaningful use” criteria we are going to have to upgrade to a new system. We are still paying for the old system….can we not wait until we have resolved that expense before we add another huge cost to it. Are you trying to put away all of the smaller practices who can barely survive now? Between Government Mandates and Insurance/Medicaid cuts, smaller practices are not going to be able to continue in business. You probably need to start a committee to head up “government owned healthcare providers” to fill the void.
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I attended the HIT Standards Committee Meeting today with a focus on security.
Most, if not all current HIT software and hardware come with built-in security measures. But, since these are selling features but not the primary medical application, often the product is installed with the default being “off” and the user being unaware of the feature, much less how to activate it, update it, and audit it.
This is like buying a new car with air bags, and after your accident in which they don’t deploy, the car dealer says “Oh, did you want the sensors in your air bag system activated?”
Examples:
1) Many small practices use Peachtree Accounting Software, which is installed with its internal audit trail feature in the default “off” setting.
2) LAN switches and routers that support a firewall and passwords, but which aren’t activated.
3) Clinical diagnostic siloed applications like ECG management systems, ultrasound images storage systems, cath lab hemodynamic systems: although their application software may freceive reqular updates, its uderlying basic operating system may not update its critical patches; or, it may have an internal communication modem which is not protected in the same manner as a seperate LAN modem.
HIPAA Compliance and HITECT Security measures must not just be built-in potential “we meet the regulations” capabilities, but intergal features that are “on” and automatically updated like my PC’s virus protection.
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7 (+5)
I have been in private practice for over thirty years and still love clinical practice.
I have a private office and consult in two local hospital stroke and head trauma units, as well as visiting numerous rehabilitation centers.
I use very advace testing and documentation technology. I am neither a techno-phobe or geek. I am a clinician who will pursue any avenue to serve my patients.
I have used IT people to counsel me throough the set up and modification of business management and clinical hardware and their supporting software. To me IT has come to meat I Tried and I Think.
I used many redundant backups for my system. A singl;e event lost 30 % + of my annual billings. Recovery of this data although incomplete required a thorough mining of and reconstructions of billing from physical records.
A paperless office is a witless solution.
Data corruption and loss are part of the definition of any system implemented. Continuity of care? Unlikely if the data is lost. Out come based documentation? Impossible if data is even compromised by entry, recovery or analysis errors.
There are no systems curently available that allow the non-quantifiable observations of the experienced physician to be posted and recovered in a reliable format.
Attempting to quantify the subjective is an oxymoron conceived by either oxes or morons.
I do believe in advancing documentation techniques, but I cower when I conceive of data being easily corrupted or compromised.
No technological defense has a life expectency beyond its implementation date, and mandated and the security required to protect personal health information
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I agree with Mr. Maglothin’s post that physician groups need to understand the big picture when going into automated systems, meaning the investment in time is as important as the financial investment. Physician and administrative leadership is also very important to successfully navigating the change and workflow management needed when implementing a new technologies. Our practice implemented a fully-integrated EHR, practice management and interoperability solution called PrimeSuite by Greenway Medical. Our system has been great. Highly customizable to our primary care workflow and affords us the capability to check patient records securely from out of the office. We appreciate the flexibility and so does our patients. We allow them to access their patient information remotely along with scheduling and prescription requests. There does seem to be a lot of animosity towards EHR companies on this site but if practices and my fellow doctors researched EHRs and looked for the ones being meaningfully-used in their specialty and practice size today, they would be much better off. We should not need the government to dictate this? I do not mind their assistance here but there are many, many success stories out there but unfortunately, most practices and practitioners are busy caring for patients and not blogging. I saw this site and felt compelled to say something as well as share my positive experience. I can offer you a list of 1,500 EHR deployments & sites that are happy and 30,000 users across America. Many or all of us have great ROI, increases in patient satisfaction, standards-based (CCD) interoperability with our community, beginning clinical research straight from our EHR, and all very happily doing this.
I hope this helps. Thanks, Michael A. Poss, M.D., FAAFP
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I am a dermatologist in private practice for the past 4 years. I have worked with both paper and EMR systems. Outside of being able to retreive patient information from home and extra storage space in the office, there have been no real benefits. I echo many comments that have been made previously. Our production is down with EMR systems. Our costs did not go down. And, I spend more time entering data and doing chart work than ever before. The technology is just not there.
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11 (+10)
I totally concur with the CV practice experience in LA. Many EHR vendors are focused on functioality without regard to usability.
Our single specialty cardiology practice(22 physicans) deployed a similar EHR that allowed incremental implementation thus accommodating physician workflow variations. This has allowed greater buy-in so as we have rolled out more complex functions (DSS with alerts and quality reporting) the practice has not experienced disruption.
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We have a large cardiology practice (Approximately 40 providers, 550 users and 10 office locations). We purchased a point-and-click EMR, but in a very short amount of time we found it to be a tremendous challenge and our physicians could not treat the same volume of patients. The physicians had essentially become data entry clerks.
In 2008 we replaced our point-and-click system with a hybrid EMR which has been very successful in our practice and embraced and adopted by all providers and staff. We implemented the hybrid EMR throughout our entire organization quickly and easily – it was a very smooth transition. With the new system, we have the full benefits of instant patient chart access, efficiency, and better patient care.
Because of the smooth transition, our employees were much more receptive to the change and our physicians were receptive to viewing patient charts in a 100% digital format.
Overall, the benefits of a hybrid EMR have proven to be:
1. Physicians do not have to change the manner in which they have practiced for years.
2. The organization does not lose revenue due to a decrease in patient visits.
3. Easy “buy-in” from providers and employees.
4. A more efficient practice that is more attentive to patient needs.
5. Higher quality patient care.
Thank You,
Jea’n Oubre LPN
Senior Health Information Specialist
Houma, Louisiana
Agree or Disagree:
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9 (+9)