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
One of the final criteria for meaningful use should be centered on the software’s ‘user-friendliness.’ Trying to force physicians into products that are not designed to fit their current workflow would result in disastrous implementations. Our physicians are extremely busy and forcing them to use a traditional point & click EMR would dramatically reduce their productivity and they’d have to curtail the number of patients that they could see in any given session. Our current system is a hybrid EMR that has allowed our physicians to maintain their current patient volume by not changing the way they see and interact with patients. The hybrid EMR still provides immediate access to charts, data-bases lab results, creates prescriptions and manages messages, but it does so in a way that does not interfere with, but rather enhances our office’s productivity.
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Our six-physician urology practice is an extremely busy one! For nearly nine years, our office has been running on a hybrid EMR solution. This electronic solution allows my physicians to maintain their high-volume schedules while allowing them to continue practicing medicine on their terms. Our hybrid EMR provides instant chart access, electronic prescribing, and messaging & tasking even though it’s not a traditional point-and-click EMR. If my physicians were forced to use a traditional point-and-click EMR, the loss in productivity would be staggering! They would need to decrease the number of patients seen in a day and for our practice, that’s just not an option.
Hot debate. What do you think?
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I am come into this discussion with a somewhat unique perspective. While currently in practice management I have worked in case management/ UR and QA in both the hospital and payor setting and have been responsible for network development for a large national PPO. I have also assisted on the design of software systems for all these products.
Today we are discussing ‘meanigful use’ – essentially how to collect data. Yet most of us who have looked at years of data already collected realize most of it falls into the ‘garbage in- garbage out’ arena.
To design effective EMR systems for all specialties – one must first endeavor to find the ‘least common denominator’ ie the minimum dataset that ALL providers collect and use. The detailed information needed by an internist, an orthopedist or an ophthalmologist are very different yet vital to their respective specialty and most importantly meaningless to each other. Docs need to share diagnosis.. the ophthalmologist may not remember what a ‘negative lachman’ means!
One of the lessons we should have learned is that the more you force the collection of data – the less meaningful the data become. .. who produces the data, who enters the data — and most importantly who certifies the accuracy of the data..
Currently I am the practice administrator for an orthopedic group. They chose a document management system before I joined them in 2001. The past eight years have served to prove they made the correct decision. The system was easy to implement, training time was minimal and yet the sytem has served to make all members of the practice – both clinical and administrative more productive. Over the years the system has been upgraded to a more hybrid EMR where minimal data entry can be used for order management and other tasks while maintaining the productive workflow in a busy orthopedic practice.
A number of years ago we did look at a ‘real’ EMR system with templates, point and click data entry – all the bells and whistles— and we realized that implementing that type of system – for our practice- would dramatically and negatively affect the productivity of all. We elected to remain with the hybrid EMR – automating what we can while not impeding the productivity of the physicians who are the prime users of these systems. While a full blow EMR may be useful in some specialities — beware trying to make a one size fits all…
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I definitely agree that any standards the government publishes need to be generic. I am a busy ophthalmologist in Connecticut, and I use a custom EMR that works very well for what I do. If I had to use a primary care EMR, I would have to cut my patient load by at least 30%, simply because the information a primary care EMR gathers has nothing to do with what I need.
Thank goodness we’re not going to have to submit to CCHIT certification for specialty EMRs. I hope that HHS does not try to replicate the CCHIT standards. We need generic standards that address interoperability, privacy, and security, and do not try to micromanage what the EMR does. CMS already has requirements for what documentation is required, and any practitioner who uses an EMR can easily make sure that his/her EMR fulfills those requirements. Trying to shoe-horn all the specialties into one standard would be a disaster.
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I am the Health Information Manager of a busy cardiology practice with 20 providers. A few years ago we had a failed implementation of a point and click EMR. The processes and flows were way to cumbersome. It slowed the process for providers to see and evaluate patients. They were required to point and click their office notes and the format was very hard to understand.
We did a lot of research before finding a hybrid EMR and am happy to say we are now chartless. With this hybrid EMR (SRS) we can ePrescribe, we have integrations with a lab, protime and dictation system, and it has excellent scanning and electronic messaging capabilities. We are a much more efficient office without the paper charts. Providers have very little data entry to do with this system so it doesn’t slow them down.
This is the way to go. I hope that when the HIT Standards Committee evaluates the options that this type of program is highly considered.
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Our group looked at several EMR’s before making the decision to implement. I learned a great deal in the process, and came to some conclusions that surprised me. The first was that, while extremely powerful, full EMRs are too much of everything for a specialist. Too much data entry, too much to look at, too much navigating through a patient visit. And we also already knew that we could spot letters from referring doctors using full EMRs in a heartbeat, and we did not like them. They are very long, clearly templated, and we came to doubt the information. We also had heard of colleagues who implemented full EMRs and saw their billed charges and collections decrease due to loss of productivity, a side effect they had not counted on.
After looking at several EMR products, we selected a hybrid EMR, and have been extremely pleased. We did not lose any efficiency and now have access to information faster and more efficiently than ever before. While initially skeptical of ROI claims, I can now see that we continue to become more efficient and have lost many of the costs we had before.
“Meaningful use” must be defined to include and understand specialties. Right now, even if we had purchased a CCHIT-certified EMR, we would not come close to qualifying for meaningful use, and if we elected to try to qualify we would certainly have to balance any increased HITECH dollars against a loss of productivity because of having to track and report on numerous data elements that are simply not relevant to the work I do. Meaningful use is currently very primary care focused, and unless the specialties are heard and understood it will be foolish for us to pursue qualifying for it.
Agree or Disagree:
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It might be helpful to this great discussion to hear from an EHR software provider, and to realize that we must also navigate HITSP standards for information exchange development that can take years to perfect. Part of that development is customer feedback and what we learn internally while balancing trying to adhere to industry standards. At Greenway Medical Technologies we’ve had a series of interoperability successes with CDA/CCD exchanging clinical and discharge summaries as well as quality reporting initiatives. Our R&D efforts have also shown good results with technical protocols like patient ID, authentication, encryption and login. We believe the impetus is on the software, not the users/ customers, to implement exchange language and a single standard (like CDA/CCD) would take away the threat of increased support costs passed along to health systems if multiple standards had to be supported.
At Greenway, we’ve had great success using the CDA/CCD standard with drug safety reporting, clinical trials, disease registries, PQRI registry reporting, decision support companies and Public Health Information Network (PHIN) reporting. Also, knowing that several state and federal entities as well as the National Health Information Network (NHIN) have settled on the CCD; we’ve found progressive interoperability with those entities as well as in pilot programs they have fostered. For instance, and we know that the Veterans’ Administration, the Department of Defense, the Indian Health Service, the Federal Hospital Association, the Centers for Disease Control, the Social Security Administration, the Center for Medicare/Medicaid Services, the National Institutes of Health, the Health Resources and Services Administrations and the Food and Drug Administration all use and support the CCD.
Connectathons have also brought us a great deal of validation in the exchange codes and we plan to continue testing at the next Integrating the Healthcare Enterprise (IHE) event this coming January. We have closely followed the leadership strategies of the HIMSS EHR Association and have repeatedly agreed internally to support its initiatives. We’re invested in the current expansion of healthcare IT toward national systemic interoperability and feel confident our customers will continue to be happy with CCD and its direction as a single standard.
In closing, to bring the industry together, Greenway supports a “transform” strategy so groups that have invested in other interoperability standards can still participate in interoperability based off the CDA/CCD single standard strategy.
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As a management consultant in health care for over 20 years and with almost 40 years of health care experience I feel the time is well past for specific data standards around Electronic Heatlh Records to be solidified and enforced. I read and hear all the excuses for not doing the right thing, but frankly most I see as self serving. In the Health and Human Services field that I work in we have implemented electronic records for many thousands of users. It is not without hard work, but it can and has been done. This is primarily a change management issue and not a technical issue regardless of what the majority of the comments indicate. If physicians do not want to implement systems, then give the money to the community health centers who will implement them. Only until the money incentive or disincentive gets their attention with physicians act. The bigger picture is that we cannot transform the health care system until health data is digitized. Hybrid systems that go only half way should not get one dime of ARRA money and should be penalized if not implemented by 2015 as required. Meaningful use should be an uncomprimising standard that is enforced for both incentives and penalties. Without the conviction to the goal, it will not be obtained. We say what has happened to the HIPAA Administrative Transactions due to lack of enforcement. Do not allow that to happen again. The price is just too high.
Hot debate. What do you think?
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Like many others I too have work with and tried many EMR’s and it is clear to me that the standards as proposed by the committee will simply not work for the great majority of healthcare providers in this country.
Dr. Alhadeff, in his post above is completely correct, what we need is “for the government to identify a core set of critical medical information, and then set a format, that can be easily transferred between practices “ and I would add between systems. Without standards that are clear and reasonable the government system will fail. As everyone knows the successful implementation of tradition EMR systems is alarmingly low. Those practices that have succeeded have had to go through a tedious and painful restructuring of their workflow. All of this work in an effort to gather more information (is it really needed?)and to provide better patient care?
After extensive evaluation and testing we choose to bypass the unsuccessful traditional EMR and to implement a Hybrid EMR. Following a very easy two month installation and a very short training period for our providers, the system was in place and working as intended. Our providers love the easy access to patient information and the efficient flow of information and messages through the system. The system paid for itself within the first year. The Hybrid EMR did not decreased our provider’s productivity ….. and it really does contribute to better patient care. This is the sort of system on which our tax dollars should be spent.
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I have seen very little noise factor on addressing the Long Term Health Care segment. Will there be applications for this seemily forgotten part of the Healthcare System.
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We chose not to purchase a traditional EHR because we didn’t want our physicians wasting their time creating a document through pull down menus, or point and clicking on templates that they would have to build. We did not want to change the way our physician workflow was conducted. Instead we wanted to enhance it. That is why we chose a Hybrid EHR.
I believe that an EHR should provide an efficient way to view the patient’s records. It should have the capability to electronically send the records, in a secure way, quickly to other providers that need them. An EHR should compliment how a provider’s workflow is conducted, since his/her time is the most valuable resource within the office.
Hot debate. What do you think?
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