In this Issue
Electronic Document Management for Physician Practices
Physician practices will realize significant changes to their clinical and administrative processes upon utilization of electronic medical records (EMRs). The transition to EMRs will lead to further opportunities to initiate changes and manage data at the health care network level as well as on a national level.
System Integration and Interoperability Challenges
The full potential of electronic medical records (EMRs) cannot be realized until all healthcare facilities have adopted them, and utilize them to exchange health information. National standards for EMR system integration and interoperability have not yet been determined or adopted. Until then, we are not realizing the full advantage of medical technology and health informatics.
Incompatibility between user interfaces, functionality and system architecture varies significantly between manufacturers’ products, and many forces are underway to improve the integration and interoperability of systems, and thus improve the status of healthcare data exchange and EMRs.
Integrating data among and from various healthcare systems is a key component, or capability, of an EMR. The integration of patient data also has the potential for streamlining, automating and structuring clinical workflow. Integration will also provide support for many different care activities, such as electronic prescribing of medications, electronic referrals, ordering laboratory and radiology tests, patient monitoring, and displaying test results. Integration and interoperability among applications will also enable healthcare providers and researchers to maintain an information and data trail for purposes of quality assurance, medical auditing, disease surveillance and epidemiological monitoring.
Interoperability will support data transfer and sharing among and beyond network systems to other networks and enterprises; image transfers; integration with non-clinical as well as clinical applications; knowledge integration and transfer; and medical terminology integration, mapping and transfer.
Data interchange is the process required for a system to read information from another, including word processing, database tables, and statistical analysis data sets. The XML format is one that is known to offer cross-platform standardization and acceptance. XML provides both machine- and human-readable format and is self-documenting. It also is capable of representing basic computer science data structures of trees, lists and records. Application integration is a process that allows the automatic execution of application-specific business logic, or commands. Application interoperability is the capability of actions in one application to drive behavior in other systems in a logical sequence. The Health Level 7 (HL7) Clinical Document Architecture is one data interface solution. Many web services also enable application interoperability because they use standards that allow applications to request information from each other.
Organizations such as community health information networks (CHINs) or regional health information organizations (RHIOs) must be in place in order to support data sharing. Two examples of RHIOs are the Massachusetts Health Data Consortium and the Santa Barbara County Data Exchange. RHIOs may have different focuses, such as disease surveillance, exchange of clinical data or administrative data. Their system architectures may vary as well, from a centralized model with a data warehouse, or a peer-to-peer model, where data remains on site but the model provides secure links to records in other locations.
An integrated health information system would be similar to electronic banking and its worldwide network, according to David Brailer, past national health information technology coordinator. A clinician could access information about a patient anytime, anywhere, even if that patient lived in Chicago and was vacationing in Thailand when he/she sought medical care. His or her medical record could be accessed at the point of care. Without integration, the health care information that has been collected and made part of each patient’s record is fragmented and not as valuable as it could be. Integration and interoperability can help eliminate test redundancy and medication errors. They can also ensure better preparedness and access to medical and public health data in times of disaster.
Many argue that interoperability should precede the use of an EMR – that it should be designed into EMRs and that the infrastructure and capacity for networking this information securely has to exist first. Others counter that interoperability will be a natural result of widespread EMR adoption.
The Healthcare Information and Management Systems Society’s (HIMSS) Systemic Interoperability Commission has recommended an interoperable medication record for all Americans by 2010. The Commission has called for product certification, data standards, standard product identifiers and vocabulary, and drug records in order to advance progress of health information technology interoperability.
Product certification calls for the Department of Health and Human Services (HHS) to support a single process to certify that healthcare information technology products meet minimum standards. HHS should also ensure acceptance, implementation and ongoing maintenance of a complete set of interoperable data standards that function to ensure that data in one part of the health system is (when authorized) available across the complete range of administrative, clinical, research and public health settings. The Commission also called for HHS to work with drug, device, and test kit manufacturers to achieve standardized identifiers and vocabulary in labels and packaging. Interoperability will also ensure that all providers have access (when authorized) to patients’ medication records.
Single-vendor solutions are not always possible in health care because of the specificity and complexity of health care’s needs. Often, a health care system will have to depend on several different vendors to provide their software needs, from pharmacy to imaging to medical records to emergency departments, and these vendors’ applications must be interoperable and capable of sharing information and data; sadly, many are not.
A fully-standardized electronic health care information exchange and interoperability (HIEI) could yield a net value of $77.8 billion per year once fully implemented, which is about five percent of the $1.661 trillion spent on health care in the U.S. in 2003, according to Jan Walker, et al (The Value of Health Care Information Exchange and Interoperability, Health Affairs, Jan. 19, 2005). Walker and her colleagues also noted that the clinical payoff from improved quality of care and patient safety could exceed the financial benefits of HIEI.
Health care providers and payers, patients, public health departments, laboratories, pharmacies and radiology centers would all benefit from system integration and interoperability in terms of knowledge shared, instant access to information, disease tracking, patient safety and security. Despite the arguments about standards, quality, cost and safety of sharing health care information nationwide and even worldwide, we must continue to work toward this goal of system integration and interoperability in order to improve our healthcare system.
Electronic Document Management for Physician Practices
Physician practices will realize significant changes to their clinical and administrative processes upon utilization of electronic medical records (EMRs). The transition to EMRs will lead to further opportunities to initiate changes and manage data at the health care network level as well as on a national level.
As of 2005, only 17 percent of doctors’ office nationwide had EMRs, according to the CDC’s National Ambulatory Medical Care Survey, which was conducted from 2001 to 2003.
The initiation of an electronic document management system is a huge task and will cause workflow process changes. The alteration of the workflow process may include critical workflow items as well as important safety precautions. The initial transition period from paper to EMRs can last as long as two years, and there will probably be a combination of electronic records as well as paper.
EMRs offer many time and money savings for physicians and their staff members. More patients can be seen per day because less time is spent on documentation. Many EMR programs have “short cuts” to speed the data collection process, and enable users to properly document services, which can justify the correct coding level, another way to increase efficiency. Paper-based medical offices that have converted to EMRs not only are more efficient, but they also save a lot of space by not having to maintain paper records. EMRs enable denied claims to be resubmitted to insurance carriers instantly. Transcription costs can be decreased or even eliminated by using dictation software that is usually available with EMR systems. Many EMR programs also automate accurate charge captures relevant to a particular ICD-9. Many commonly overlooked procedure and supply codes are also captured.
Many vendor solutions are available for electronic document management. Review them carefully in order to ensure that your practice purchases the right solution to ensure the best return on your financial investment. Many vendors allow their products to be tested for a period of time to make sure it’s suitable. Talk to other physician practices and see what products they recommend and why. Often, the health care network makes specific product recommendations that must be respected, and that is to ensure interoperability among all its providers.
During the transition, patient information must be secure, and patient information must be kept private. Medical record content integrity must be maintained, along with clinical workflow integrity. The continuity and quality of care must not be compromised during the transition period.
It goes without saying that access to storage media, hardware and software must be controlled at all times. Hardware that is kept in an examining room or area where patients might have access to it should be locked to prevent access. Monitors that are visible to patients should not display information about other patients, such as diagnostic or scheduling information. Every user must have his/her own identification and password. Audit logging should be enabled in order to record each and every user’s actions while logged on. An adequate security network, such as firewalls, second factor authentication and Virtual Private Networks, is vital in order to verify that only authenticated users can access patient medical records.
Today, many physicians are opting for Pocket PCs in order to speed dictation and electronic prescribing and result verification. These interface with office software to ensure that everything is automatically recorded on patients’ records.
In case of a product withdrawal by the FDA or manufacturer, physician offices that utilize EMRs can electronically find all patients currently taking that drug or who have received that type of implant, for example, and send out a letter to them, saving countless hours of searching.
In summary, EMRs are here to stay, and physician offices can realize many benefits in terms of time and money, not to mention efficiency and safety.
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Previous Articles
Healthcare Standards and the National Health Information Network
What to look for when selecting an Electronic Health Record (EHR) Vendor?
State Data Exchanges Lacking
Funding for infrastructure will continue to be a huge challenge to the stability and longevity of state-based health information exchange (HIE) projects, according to a report recently released by Avalere Health, a strategic policy advisory firm based in Washington, D.C. The report, titled “Evolution of State Health Information Exchange: A Study of Vision, Strategy and Progress,” noted that none of the eight state-level HIEs examined achieved a sustainable operations or funding model.
The information technologies that are used in HIE projects to exchange health data may be incompatible with each other, according to the report. Few Medicaid programs are involved in community or state HIE initiatives, also known as regional health information organizations (RHIOs). Medicaid is only involved in two of the eight state programs examined by researchers. Of the 101 community projects surveyed, Medicaid is mentioned as a stakeholder in 19 of them. The report also determined that most state programs have yet to begin exchanging clinical data and many have not yet actively engaged a large spectrum of stakeholders.
The study was funded by the Agency for Healthcare Research and Quality, a federal agency. The report can be viewed at www.avalerehealth.net.
HIMSS Electronic Health Record Vendors Association Efforts Impact Certification Process in a Positive Way
Electronic Health Record Vendors Association (EHRVA) is a trade association of electronic health record (EHR) vendors that join together to lead the healthcare information technology (HIT) industry in the accelerated adoption of EHRs in U.S. hospital and ambulatory care settings. EHRVA represents approximately 90 percent of the installed EHR systems in the U.S. EHRVA is a partner of the The Healthcare Information Management Systems and Society (HIMSS). The association is providing extensive resources to staff the Certification Commission for Health Information Technology (CCHIT) in the process of EHR certification.
A certification framework is nearing finalization after 18 months of dialogue between EHR vendors and users.
EHRVA is optimistic that the CCHIT framework can become a vital and efficient means of increasing ambulatory EHR adoption. The ambulatory EHR certification process is a major milestone for the healthcare industry, utilizing the CCHIT framework.
EHR vendors support certification because they believe it will provide confidence in their products. Certification will enable support for interoperability, standardization and certification. Vendors view certification as a continuing process, not one with an endpoint. Their goal is to ensure provider adoption and acceptance of the certification process.
Future interoperability, incentives and provider reimbursements may all require certified EHRs
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