EHRSystem Developing a Functional Model and Standard

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EHRSystemDeveloping a Functional Model and
Standard

• HIMSS 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 _at_ 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.ht
  ml

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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 IOMs Definition of an EHR-S

• Includes
• 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
• immediate electronic access to person- and
  population-level information by authorized, and
  only authorized, users
• provision of knowledge and decision-support that
  enhance the quality, safety, and efficiency of
  patient care
• 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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IOMs 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
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 Underwood
• Siemens/ charlene.underwood_at_siemens.com
• Pat Wise
• HIMSS/ pwise_at_himss.org
• Ed Larsen
• E. R. Larsen, Inc./ erlarsen_at_erlinc.com
• Joyce Sensmeier
• HIMSS/ jsensmeier_at_himss.org