The HL7 Electronic Health Record System Functional Model

1. The HL7 Electronic Health Record System Functional Model Status Update and Outlook HIMSS Audio Conference December 2, 2003 Edward R. Larsen E. R. Larsen, Inc.

2. Background and History • Last spring HHS came to HL7 seeking an EHR System (EHR-S) Functional Model “ANSI Standard” by January 2004 • HL7 board accepted the challenge and assigned responsibility to its EHR SIG • HIMSS joined HHS, VA and DOD as a sponsor • EHR SIG prepared a Functional Model and integrated the IOM Letter Report on EHRS requirements into a Draft Standard for Trial Use (DSTU) ballot in early August • EHR Collaborative formed to conduct town hall meetings and report back to sponsors • The ballot did not receive the 2/3 votes necessary for a DSTU and the negative votes could not be reconciled at the HL7 September meetings in Memphis

3. Progress since Memphis • Message from the Memphis Meeting • Develop a new DSTU to finalize at January meeting • A roadmap • Simplify • Functional list • Rationale • Clarify • Functional definitions (omit content) • Priorities • Delegate care settings and priorities to Realms • Including the new US realm

4. Progress since Memphis • EHR SIG set up five sub-work groups formed • Direct care functions • Supportive functions • Infrastructure functions • Care setting profiles and priorities (US) • Coordination • The SIG and sub work groups have been conducting weekly (or twice weekly) conference calls • Extensive use of HL7 list server to edit documents

5. The EHR-S Functional Model • Standard Set of EHR System (EHR-S) Functions • Definitions and rationale • Applied to care settings, such as hospital or ambulatory care • Assigned priorities • Conformance is not part of current DSTU - deferred • Conformance could insure “common” functions such as “manage allergy list” or “enable use of order sets” across vendors and providers • Not content standards for the EHR itself • Not interoperability standards for EHR-S or extracts

6. Current Status • New Functional Outline • Direct Care • Care Management • Clinical Decision Support • Operations Management and Communications • Supportive • Clinical Support • Measurement, Analysis, Research and Reports • Administrative and Financial • Information Infrastructure • ~ 180functions - each includes Function Name, Statement (definition) and rationale • Revised functional outline finalized by December 5

7. Example of Functional Outline

8. Rationale IOM Plus 2 1. Support delivery of effective healthcare2. Improve patient safety3 Facilitate management of chronic conditions4. Improve efficiency5. Facilitate self-health management6. Ensure privacy, confidentiality

9. Current Status • Care Settings and Priorities • Defining Care Settings • Hospital • Ambulatory • Nursing Home • Care in the Community • Priorities • Essential Now • Essential Future • Optional • Not Applicable • Present as a Grid • Beginning work on US care settings December 2 with mid-December deadline

10. Current Status • Drafting second DSTU ballot • Informative Text • Functional Outline • Care setting priorities (US only) • Releasing informative narratives to accompany the ballot this week • Will finalize ballot at HL7 Working Group Meeting in January in San Diego

11. The Big Picture • EHR Systems are the most important contribution by IT to improving patient safety, care effectiveness and efficiency • EHR-S underlies our highest priority initiatives: CPOE, bar-coded meds, clinical decision support applications • e-prescribing in new Medicare bill – HCIT viewed as central to healthcare transformation • EHR at the center of newest IOM Report “Patient Safety: Achieving a New Standard for Care” • EHR S may be used by CMS in developing quality metrics for “pay for performance” demonstrations • EHR S core functions are heart of Leapfrog Ambulatory Care Safety (joint with CMS/AHRQ)

12. The Big Picture • EHR Systems are happening with or without the HL7 standard • Make sure we do no harm (e.g., block, derail or produce “bad” standard) • Make sure we respond with a good first step standard • Understanding that much more must be done • Make sure we work with sponsors to use effectively

13. HHS Goals In Pursuing HL7 EHR Functional Standard • Letter on behalf of HHS to HIMSS dated November 12th • Available on HL7 EHR List Server (see J.Sensmeier 11/26) • Reaffirms EHR-S as essential requirement for the NHII, patient care and other uses • Understands that further work will be required • Recognizes this as public-private sector effort

14. What’s next? • Outreach through the EHR Collaborative – December through February time frame • HL7 working group meeting to finalize the ballot in January • Validation with key stakeholders at HIMSS in February • Publish the DSTU Ballot in February-March time frame • Ballot reconciliation at May HL7 working group meetings • All of these are open to any and all participants

15. Resources • HL7 EHR SIG • www.hl7.org/ehr • HL7 List Server • Must sign up at www.hl7.org (select list servers) • www.lists.hl7.org • EHR lists include general, announcements and work groups • EHR Collaborative • www.ehrcollaborative.com • HIMSS EHR • www.himss.org (select electronic health record) • Ed Larsen • erlarsen@erlinc.com