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April 2007 — Volume 2, No. 4

In This Issue

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Terms and Definitions

CPOE: Computerized Practitioner Order Entry - 1. An order entry application specifically designed to assist clinical practitioners in creating and managing medical orders for patient services and medications. This application has special electronic signature, workflow, and rules engine functions that reduce or eliminate medical errors associated with practitioner ordering processes. 2. A computer application that accepts the provider's orders for diagnostic and treatment services electronically instead of the clinician recording them on an orders sheet or prescription pad. Also known as computerized physician order entry and computerized patient order entry.

eMar: Electronic medication administration record. An electronic record keeping system that documents every drug taken by a patient during a hospital stay. This application supports the five rights of medication administration (right patient, right medication, right dose, right time, and right route of administration) by utilizing bar coding functionality with pharmacy medication dispensing and nursing medication administration services. This functionality is implemented to reduce medication errors. This functionality requires tightly coupled data flows between the CPOE, pharmacy, automated dispensing machines, robotic devices, and nursing medication applications. Medical errors are reduced, drug inventory costs are reduced, and billing is more accurate.
Source: HIMSS Dictionary of Healthcare Information Technology Terms, Acronyms and Organizations, 2006, HIMSS

News Briefs

First HIT Bill Introduced in the House
Congressmen Charles Gonzalez (R-TX) and Phil Gingrey (R-GA) introduced the National Health Information Incentive Act, bipartisan legislation that takes significant steps towards improving the quality of health care received in America. The bill targets small physician practices as the focus of efforts to achieve wide scale adoption of health information technology (HIT), the implementation of which will increase efficiency in health care practices and provides broader access to medical records.
Read more


DC Receives $5M Grant for EHRs
With help from a $5 million city grant, the D.C. Primary Care Association will be signing up a software company before month's end to link the electronic medical records of six community health care clinics for the underinsured. The six-clinic electronic network will eventually stretch across all the city's hospitals, medical practices, clinics and pharmacies.

Connecting Communities – May 3 and May 10

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Special Edition On: Certification Commission on Healthcare Information Technology - CCHIT

The Certification Commission for Healthcare Information Technology (CCHIT) is an independent, nonprofit organization that has been officially recognized by the federal government as a "recognized certification body" for electronic health record (EHR) products. Its mission is to accelerate the adoption of health information technology by creating a credible, sustainable product certification program. The certification requirements are based on widely accepted industry standards and involve the work of hundreds of expert volunteers and input from a variety of stakeholders throughout the health care industry. More information on the Commission and CCHIT Certified products is available at www.cchit.org. "CCHIT" and "CCHIT Certified" are service marks of the Certification Commission for Healthcare Information Technology.

Read on in this edition of the Digital Office to learn more about CCHIT.



Certification Commission Announces New Certified Products

2007 ambulatory certification program opens May 1

CCHIT announced today (April 30) that 30 additional electronic health record (EHR) products for office-based physicians have been certified, bringing the total number of certifications to 81 since the program began one year ago. All certified products are listed on www.cchit.org.

The Certification Commission also released data indicating that during the 2006 certification period, a total of 98 ambulatory EHR product inspections were conducted. Full compliance with the criteria was demonstrated by products in 83 percent of those inspections. The Commission also estimated that more than 40 percent of companies with ambulatory EHR products have been certified.

"Certification of electronic health records encourages adoption of health IT and will help make better care at lower cost available to all Americans," HHS Secretary Mike Leavitt said. "I applaud CCHIT's success in certifying more than 40 percent of companies selling ambulatory EHRs, and look forward to seeing that number increase over time."

"We are extremely pleased with these first year results, not just because of the number of products certified, but also because such a wide diversity of companies and organizations have brought EHRs for certification. A healthy percentage of them are small – under $1 million in revenues – while on the opposite end of the spectrum we see one of the country’s largest organizations, the Department of Defense. There are commercial as well as nonprofit entities, internally developed systems, even open source software projects," said Mark Leavitt, MD, PhD, Certification Commission chairman. "I think this finally lays to rest any concerns about certification restricting the marketplace."

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Views From the Top

James Morrow, MD - Commissioner, CCHIT - "The efforts by CCHIT are a landmark in the healthcare industry. The time and energy (and comparable payback) involved in learning an EHR can now be done with some assurance that the product is mature enough to support the ongoing needs of the providers and patients."

 

 

Denni McColm, CIO - Commissioner, CCHIT - "I do think it is exciting that we are continuing to have such interest in certification. One of the most interesting things is that is isn't just the well-known ambulatory EHR vendors that serve primarily large ambulatory practices that are seeking and gaining certification. The vendors who are certified to date include many vendors that primarily serve small and solo practices. That's where the real challenges have been with adoption of EHRs - in those small and solo practices - so certification is really serving the intended purpose of making that investment by independent physicians less risky."

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2007 Ambulatory Certification Program

Applications for certification of ambulatory EHRs under the 2007 criteria will open on May 1, 2007. Among a number of new requirements this year, systems must be able to send prescriptions and refills to pharmacies electronically. In addition, vendors must demonstrate their product’s ability to electronically receive standards-based lab result messages.
"This year’s new requirements go a long way toward more complete interoperability of EHRs and health information networks in the years ahead," Certification Commission executive director, Alisa Ray, said. "We’re looking forward to building on the success of our first year."
Final criteria for 2007 ambulatory certification, along with test scripts, a revised handbook and contract agreement are available at www.cchit.org.

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Certification Commission Announces New Work Group

CCHIT recently announced a restructuring of its volunteer work groups as well as plans to recruit additional staff to support development of a significantly expanded certification program for 2008.

Under the new structure, universal electronic health record (EHR) requirements applicable to all settings will be addressed by a new EHR Foundation work group. The current work groups addressing office-based (ambulatory) and hospital-based (inpatient) criteria will continue to focus on the requirements specific to those two settings, supplemented by a third work group developing criteria for Emergency Department systems. Another new group will be formed to begin developing certification criteria for health information networks, the third phase of the Commission’s contract with the U.S. Department of Health and Human Services.

Besides those five work groups, there will be five new "expert panels" that will concentrate on security, privacy, interoperability, and the new expansion areas of children’s healthcare and cardiovascular medicine.
"Volunteers, who are responsible for CCHIT’s successes, are finding their time spread thinner than ever. I believe we must use those resources even more efficiently this year, making fewer demands on their time while gaining the maximum benefit from their expertise," said Mark Leavitt, M.D., Ph.D., Commission chairman.

To support this goal, the Certification Commission will offer two types of volunteer roles: membership in "sustaining work groups," which are similar to the current volunteer model, or serving on the new expert panels to address specialized issues in depth.

"The sustaining groups and expert panels will have different work styles and time commitments. Just as we’re making certification more flexible to meet specialized needs, we’re custom-tailoring our volunteer models so people can find the best fit," said Leavitt.

Applications for volunteers CCHIT work groups will be accepted online through May 7. Visit www.cchit.org for more information.

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Commission Recruits New Staff

To support its growth and expansion and to ensure that volunteer resources are used efficiently, the Commission also will begin recruiting additional staff members, according to CCHIT executive director Alisa Ray. A full description of available positions and information on how to apply is posted at www.cchit.org on the Web site.  

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The 20-Second Survey - CCHIT – Certification of Ambulatory E-M-R Products

Survey graphicIt’s time for the May 2007 “20-Second Survey” from the Digital Office.  This month’s survey is on certified ambulatory EMR products from CCHIT.  So – set aside those 20 seconds to take this survey now and be entered to win a HIMSS gear item.

The winner of the March 2007 survey was Miriam Paulus CPHIMS, who will receive the new HIMSS book, Improving Quality and Reducing Cost with Electronic Health Records: Case Studies from the Nicholas E. Davies Awards.

The March survey focused on outsourcing. 

Almost all of the respondents said they would outsource services to a company in the United States with administrative services, such as billing and claims, as the top choices for outsourcing.  Data development and transcription services followed to complete the top four selections for outsourcing.

Respondents also cited other outsourcing options as noted below.

Just over half of the respondents were not interested in outsourcing services outside of the US.  They listed the following reasons for keeping their business inside the country:

When asked what services they would outsource outside the US, respondents again selected administrative work with claims as the top choice.  Billing, data analysis and data development followed with almost three quarters of the respondents indicating they would outsource these tasks.

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Making the Connection between RHIOs & Community Physicians

Coming soon to a community near you…  Regional Health Information Organizations…

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Alice Loveys , MD

…Across the nation, RHIO formation is under way.  Patient safety and cost savings are driving this national trend. RHIOs look to interconnect disparate health care records for patients seeing multiple providers.  Cost savings for the healthcare system may come from the elimination of adverse drug effects and the reduction of redundant lab and imaging tests. By connecting to a RHIO, community doctors may have access to up to date medical information at the point of care.

As providing healthcare becomes more complex, the need for accurate, timely information is more critical than ever.  Medicare patients see - on average - six unique providers a year. Almost 80 per cent of healthcare is provided in ambulatory settings.  Being able to capture and share data in an effective way is dependent on doctors in that setting.  

For the community physicians to participate, they need to make an investment in hardware and Internet connectivity.  They also need to look at their current work flow and see how it may change as data is sent now in aggregate electronically.  The potential for savings to the overall system may be clear, but how will the community physician benefit from this investment?  Who pays for the RHIO and for the connectivity?  

Perhaps the simplest answer for the community doctor is to track what amount of time currently is spent by the office staff (or themselves) processing patient data coming in (lab tests, imaging results, consultant reports, admission and discharge summaries, etc).  In a paper system, this involves opening the mail or printing the fax, pulling a chart, filing the information and refilling the chart.  The estimated cost of a chart pull is anywhere from $3 to $8 per chart.  Docs only need to multiply the number of reports coming in per week by three (at the low end) to gain some understanding of the potential savings.  

What about time tracking down missing information?  Add this amount to the total.  The value for complete information when making medical decisions is well worth the investment.

How will the data be shared, who will have access to the data, and what privacy rights will the patient be assured of are just a few of the questions being considered in the formation of a RHIO.  Is the data correct and current and can the physician trust the data coming from this new source?  

Physician input is critical in answering these questions.  Most RHIOs forming are actively seeking physician input to work through these very issues. 

I encourage docs to get involved through their medical society or local hospital and make a difference for how healthcare is delivered.

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Thinking About Implementing Health IT

The Common Ground Health Clinic in the Algiers section of New Orleans soon will be connected with an electronic medical record system. HIMSS has partnered with the clinic to help it build its EMR system.  Through the donations of individual and corporate members, HIMSS presented a check for more than $38,000 to the clinic. In addition, HIMSS corporate members donated software, consulting time and other items for the clinic. Read the complete HIMSS news release to learn more about the clinic. 

Common Ground Health Clinic
Making the EMR happen at Common Ground Health Clinic are: (left to right): Brian Rasmussen, Allscripts; Chris Williams, Louisiana Health Care Review; David Collins, HIMSS; James R. Morrow, M.D., Healthcare Information Technology & Research, Inc.; Tung Ly, Louisiana Public Health Institute; Anne Mulle, Nurse Practitioner, Common Ground Health Clinic, Algiers, and in front, Antor Ola, Executive Director, Common Ground Health Clinic.

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Already There…Implemented Health IT

Dr. Garland Byron
Dr. Garland Byron

Dr. Garland Byron is a board-certified, internal medicine physician, practicing at Arnett Clinic in Lafayette, Ind.  More than 10 years ago, Dr. Byron saw the benefits that a computer could provide in the provision of care and developed an EMR that he used for many years inside an organization that was paper-based.

EMR Benefits
When asked about the benefits of using an EMR, Dr. Byron identified several key areas:

Preparation Tips
Dr. Byron suggests that any provider who currently works with a paper record system to begin to prepare for the digital record by:

If this information is not available in the chart, then ask the patient at the next visit.  Use the preparation time to prepare for transition to the EMR to update all facets of the patients’ history.  This worksheet can be used as the main database for putting information into the EMR when it’s time to implement.

Dr. Byron transitioned from his own EMR to another system, which meant he had to address other challenges such as:

Dr. Byron describes himself as a “more global thinker and problem solver” while others may be more linear. He has learned to use the flexible aspects and features of the EMR to adjust it to his work style and workflow. These same challenges may be experienced by providers who have controlled the paper records of their patients and now find themselves sharing clinical information in real-time with several hundred providers.

Be Patient During the Transition
One of the common concerns about migrating to an EMR is the ability to be as productive using the EMR as with the paper record. Dr. Byron found that patience is the best policy. Even with 10 years of experience using his EMR, it took two weeks to transition from his EMR program to the commercial solution and get back to pre-conversion production. Others have taken two to three months, and some longer, but almost all have been able to return to their pre-EMR numbers.

More Tips
Other tips to consider when making the transition to an EMR:

Final Advice from Dr. Bryon
“Have no fear of experimenting. Sometimes you’ll guess right and other times wrong. That’s what learning is all about. There is some tedium but overall, I found things to be fun and exciting.”

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