EHR–System Developing a Functional Model and Standard

1. EHR–SystemDeveloping a Functional Model and Standard HIMSS Audio Conferences August 7 and 14, 2003 Sponsored by the HIMSS Foundation

2. 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

3. 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.

4. Charter • Call to Action: HHS Secretary Tommy Thompson Announcement – @ 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.html

5. 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.

6. HL7 EHR System Functional Model and Standard • Scope and Definition • Framework • Content • Functional triplets • Care Setting Profiles • User Profiles • Tools • Hierarchy • Submittal Forms

7. 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.

8. HL7 EHR-S Framework

9. HL7 EHR-S Framework

10. 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.

11. 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

12. 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)

13. The IOM’s 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.

14. Primary and Secondary Uses of an Electronic Health Record SystemAdapted 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

15. Health information and data Results management Order entry / management Decision support Electronic communication and connectivity Patient support Administrative processes Reporting & population health management IOM’s Core Functionalities for an Electronic Health Record System

16. IOM EHR Capabilities High Level Abstraction

17. 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

18. Status of the Draft Ballot • Ballot available August 7th • Ballot closes on September 5th • 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

19. First Look at the DSTU • We can all support it but it needs further work • Agree on a definition of the EHR-S • Develop a more useful functional hierarchy • Provide more details on functions • Clarify “essential” and “desirable” • Add more on medication administration, decision support, multi-disciplinary workflow and clinician documentation functions • Clarify infrastructure functions and secondary user functions • Participation is the best way to make it a better standard

20. HIMSS Role • HIMSS has strongly supported a universal EHR and applauds this effort • Submitted its EHR 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 • Four more cities – www.ehrcollaborative.org • Will draft a response to the Ballot by August 15 for comment by members

21. 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!

22. Contacts • Charlene Underwood Siemens/ charlene.underwood@siemens.com • Pat Wise HIMSS/ pwise@himss.org • Ed Larsen E. R. Larsen, Inc./ erlarsen@erlinc.com • Joyce Sensmeier HIMSS/ jsensmeier@himss.org