Let’s be explicit about the benefits to medical care and what’s at stake in encouraging IT adoption. EHRs, properly designed and used, can transform the process in many ways: records are instantly accessible, incoming information is immediately figured in, and diagnoses and other treatment decisions are made with a fuller knowledge of what’s ailing the patient and what to do about it. EHRs reduce wasted movement, duplication, dictation-transcribing and other inefficiencies. Data collected from many EHRs constitute the raw material of insightful observations and otherwise unattainable intelligence about the sickness and health of large groups of people and what’s succeeding or failing in efforts to deliver care more effectively.
To deliver on those prospects, as well as address the concerns of physician buyers as expressed above, any EHR on the market must be organized to accomplish a set of objectives and be held to them by an objective and trusted advocate for the physician community.
If you’re interested in reading more about CCHIT’s position on this effort, please download An Introduction to Health IT Certification.
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I am a Registered Nurse with over 18 years of experience, mainly in Long Term Care/Skilled Nursing Facilities (SNF). As a Director of Nurisng for 13 of those years I have managed not only Sub acute Medical/Rehab units/facilities but also Traumatic Brain Injury, Alzheimers/Dementia/Chronic Mentally Ill, Hospital based nursing home, and what would be known in the field as “Garden variety of Long Term Care.” I am currently in a position assisting the corporation I work for in developing their Electronic Health Care Record System to be rolled out to all 190 of their SNF throughout the United States. EHR will manadated in all SNF’s by 2015 is the most current information that I have. Will CCHIT be involved in any of the criteria development for our division of health care either independently or in conjunction with the Department of Quality Assurance and CMS? I am also wondering if you have developed or will develop an IT/Certification program for SNF’s or will your current certification program cover SNF’s as well.
The ability of current and future HIT applications and electronic health records systems to incorporate and integrate the documention of pharmacists’ clinical, direct patient care services and medication therapy management activities (in addition to the medication product dispensing records) should be actively promoted and incorporated into any process for certification of HIT systems. Given the vital role of medication use in the care of chronic medical conditions of both the senior population and the population at large, effective access to information and the electronic sharing of consultative recommendations, pharmacotherapeutic care plans, and other medication-related data is essential to quality patient care. The American College of Clinical Pharmacy (ACCP) urges the inclusion of processes to incorporate these data as required elements and standards within any process for certification of HIT systems.
ACCP would welcome the opportunity to work with other interested parties to address this key element of an HIT certification framework.
C. Edwin Webb, Pharm.D., M.P.H.
Associate Executive Director
Director, Government and Professional Affairs
American College of Clinical Pharmacy
1101 Pennsylvania Ave., NW
Suite 600
Washington, DC 20004-2514
(202) 756-2227
Hi – I am an I.T. consultant for businesses, including several medical facilities. Of course, they all have many questions regarding the upcoming requirements and initiatives. Is there or will there be a specific certification for IT professionals?
In response to Ms. Corcoran comments and questions about development of a certification program for EHRs used in skilled nursing facilities and other long term care settings: CCHIT is planning to begin development of a program for products used across the long term care spectrum in July 2009 with a planned launch in July 2010. We will review federal requirements during that development. The plan for expansion can be reviewed at http://www.cchit.org/expansion . We will begin work group recruitment for that development work on March 23 through April 20 at http://www.cchit.org. We encourage those with expertise to apply. Interested parties may also participate through CCHIT’s regular public comment periods on criteria and test scripts held throughout the year.
In response to Dr. Webb’s comments about inclusion of pharmacy services and incorporation of pharmacy data as required elements and standards within any process for certification of HIT systems: CCHIT encourages those who have expertise in this domain to apply for participation during its upcoming development work group recruitment period. This might include participation in any number of groups, including the ambulatory, inpatient, or long term care groups. We will begin recruitment for new development work on March 23 through April 20 at http://www.cchit.org. Interested parties may also participate through CCHIT’s regular public comment periods on criteria and test scripts held throughout the year.
In resp0nse to Mr. Berry’s questions about certification for IT professionals: The Commission’s scope of work is limited to developing certification criteria and processes for health IT products and services. It does not extend to individuals at present.
Sue Reber
Marketing Director, CCHIT
I am an IT consultant and have led many systems integration projects for clients like WellPoint, Cigna and CareFirst, as well as a HL7 implementation. Exchanging of data/information across multiple players in the health industry could lead to poor data integrity when there is so much data redundancy. How would anyone know, which data is correct? Are there any plans to have a central repository with some form of the EHR, let’s say at a county or state level that will be source of truth and which will have references to these other EHR systems?
In response to Mr. Berry’s questions about certification for IT professionals: I’m also an I.T. Professional; but interested in moving into the medical sector. Here’s what I’ve found. On the U.S. Dept. of Health and Human Services website, there’s a listing of HIT Certification Resources – http://www.hhs.gov/healthit/certification/resources/ . I believe these are the organizations providing professional HIM certifications:
American Health Information Management Association – http://www.ahima.org/certification/index.asp
Healthcare Information and Management Systems Society –
http://www.himss.org/ASP/certification_cphims.asp
However, since I have no experience in this area, please correct/add to this info.
Question to Sue Reber (CCHIT):
In your response to Mr. Berry’s question, you indicate the CCHIT does not have a certification for IT professionals AT PRESENT. Is there any discussion, in your organization or others, about a new certification for IT professionals? Can you provide details?
I’m considering returning to school for a bachelors or masters at a CAHIIM Accredited HIM Program, so I can sit for an AHIMA exam / certification. However, if there will be a new organization providing IT certification(s), other than the 2 listed in my comment above, I may postpone my decision.
In response to Mr. Rai’s question about a central repository: CCHIT HIE criteria do not mandate or pre-suppose that there is a community EHR repository. This may or may not evolve in the marketplace. And it could be patient-centered. As this progresses, CCHIT will develop criteria appropriate to this capability if necessary.
We agree that there will need to be a determination of how to arbitrate or highlight data discrepancies across data sources. We anticipate that guidance and standards in this area will emerge under the governance structures created under the American Recovery and Reinvestment Act.
In response to Ms. Thorsen’s questions about professional certification for individuals: The Commission has no plans for undertaking this. You have already correctly indentified a few organizations that can provide guidance. You might also review the work of the American Medical Informatics Association (AMIA).
Sue Reber, Marketing Director
CCHIT
As I read articles in the medical press, those written by end users of various electronic medical record programs, (not those who write and/or sell them), I feel less alone in my sense that these programs were not written so much for the primary care physician as they are for the subspecialist and the Hospitalist. My problem is the loss of the narrative which is especially useful in the primary care setting where a diagnosis has eluded us as the history takes us into dead ends and the dark corners where people actually live.
In the hospitals, their ERs and subspecialty practices where the EMR is already very useful, if not indispensible, patients are admitted or refered in for the care of patients with already well categorized conditions. That is, the body system or organ in trouble has already or is easily identified and the right subspecialist takes off from there with his/her very specific, in-depth training, and instrumentation to hone in on a more finite set of problems and interventions. There is no point in asking far-reaching questions for which the answers may lead you down many paths. The set of questions and the set or answers can be listed as in a drop-down menu or one or two word phrases that fit into a box. This is data. It can usually sort electronically into algorhythm(s). It can be utilized to help answer research questions.
Not so the primary care practice. The far-ranging possibilities in our “interesting” cases is often what drew us into primary care in the first place. Let me illustrate with an example from my practice. I am a Pediatrician with additional training in Adolescent Medicine. I leave it to you to decide if I am, therefore, a subspecialist. For me, this is as primary care as it gets. A female teen was refered to me after three hospitalizations and many tests led to the diagnosis of Chronic Fatigue Syndrome, a diagnosis of exclusion if ever there was one. I requested the records from her previous doctors, in particular her primary care physician throughout her short life. Not a summary of any kind. I wanted every page. Did you know that if you sit down and read the complete, unedited narrative of a person’s medical record in one sitting there is a flow to people’s lives? When she was six years old that flow changed. A summary would NEVER have revealed it. A set of categorical responses to categorical questions would NEVER have picked it up. I wasn’t clever. I felt the change. She began to be seen in clinic for easily diagnosed problems that had vague, or non-specific, or no objective findings. I read back to find the point after which the flow changed. There I found the only reference in her chart that mentioned the inclusion of a genital inspection along with the rest. I called the physician who had taken care of her for sixteen years and I asked why he notated a genital exam for the first, (and last), time. There was silence on the other end. Finally he said in a different tone of voice that he suspected the possibility that she had been touched inappropriately because of the subtle appearance of vulvar irritation. But such an accusation carries a huge consequence of major family upheaval, destroyed lives, even lost lives. Besides, he told me, the person in their small community he would have to report this suspicion to happened to be her mother. Fortunately, a psychiatrist fairly new to the town was willing to take on the case and turned her life right side up in fairly short order.
To date, I don’t believe an EMR program has been conceived that can really absorb this kind of narrative. When doctors write a patient encounter into their computer, they, (I), always summarise to some extent and rarely record the exact words of the patient that can be very telling. Am I wrong? Has anyone figured out how to both record the narrative and its subtlities into an EMR and preserve the functionality of the EMR? Until they do, the EMR as presently conceived is an inappropriate tool for the primary care practitioner. Not all technological advances equal progress.
I own a document imaging company that has been digitizing records for hospitals, gonernment agencies, etc for almost 20 years. In order to get a complete patient history, are practioners encouraged to digitize current files into an EHR system? Is there a plan to import paper files into an EHR system after that new EHR system has been implemented?
The DoD was successful in addressing most of the concerns listed here. I am a software analyst for the DoD EHR for the past 4 years. It is a very robust system and houses millions of records. the common denominator being the individuals affiliation with the services. This program used in all branches. While it has some program limitations and is primarily for outpatient use at this time, it works as a centralized source of information for the providers to includes patient notes, labs, rads, meds and link to the VA’s EHR. The system works but in the civilian communities, there would have to be some major compromises in order to nationalize 1 EHR.
I applaud CCHIT and HIMSS for their vision in establishing a certification for Health IT. The Interop. Clearinghouse plays a similar role in the public sector for IT infrastructure technologies using a consensus standard called the Architecture Assurance Method. This is a pre-testing, architecture based approach for weeding out poorly formed requirements specifications and technologies by inspecting the “blueprints” before they build.
AAM was successfully applied in creating the very first EHR called the Govt Wide Computer Based Patient Record or GCPR. It has also been attributed to driving successful IT program implementations for the Govt Printing Office FDSys program, the Patent Trade Mark Office’s Patent Automation System, the Department of Homeland Security Enterprise Portal and many more. The point is that for any healthcare IT stack, nearly 70% of the solution is common infrastructure and not healthcare specific. There is a wonderful opportunity to partner so that the entire IT solution stack can be effectively assessed.
Please call; 703 768 0400 if you see value in working with another public service institute. Visit http://www.ICHnet.org/sail.htm to see white papers from OMB, ICH and Industry Advisory Council on how we address these common issues.
Medicine is as much an art as it is a science, not that art is devoid of science; but certainly not all ‘medical’ decisions are based on ‘scientific’ data or a set of choices from a drop down menu. If we can reconcile ourselves to the limitation that EMR is not the answer to all our patient care issues we will be in a better frame of mind to design and implement EMR technologies that are meaningful to the practice of medicine while fulfilling the purposes of payer driven documentation.
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