Thursday, May 10, 2007

Quality Assurance, Standards, Interoperability

By coincidence Steve Beller, PhD in his recent blog on posted some information relevant to health information transparency, and health information exchange. The RHIO monitor has attempted to keep interested readers somewhat current with these developments in the past two years. Readers may go to to read more about RHIO attempts in Southern California and elsewhere.
A group of standards for interoperability have been established for electronic medical records by the CCHIT (Commission for Certification of Health Information Technology. These vendors can be found at CCHIT's web site, and also at CALRHIO These are standards for electronic interoperability and functionality of an EMR. They however do not standardize nomenclature for diagnosis and procedures, nor pay for performance metrics. There are diagnostic standards, (ICD codes) and procedure codes (CPT codes) that are used by medicare for data mining, however these statistical figures are derived from financial data and not true clinical information.
Due to HIPAA regulations true transparency will never exist, to prevent violation of privacy rules. Statistics will be stripped of patient identifying information.
Organizational strategies are ubiquitous and range from non profit collaboratives, private foundations, community clinics, and now some entrepeneurial asp models for EMR and RHIO portals. One barrier has been a "sustainable business model."
A significant number of RHIOs have failed, the most recent in Santa Barbara after ten years of attempting to overcome barriers of self interest, mistrust and loss of public funding grants for startups.
The situation is highly complex and cannot be oversimplified. While many proponents liken the banking industry and it's information structure to health care IT, they are radically diffferent, and not as simple as inserting an atm card into a terminal...While banks have developed highly secure systems, additon and subtraction of simple numbers is not the same as a medical record system, much of which is analog in nature rather than digital.

More about these efforts in my next post. Steve is on the right track and his comments are all on the mark. Most physicians are so busy with medical care the don't have time to be proponents of HIE, although if given a cost effective system that is non disruptive they would readily accept it. The devil (as always) is in the "details".

Tuesday, May 8, 2007

Before you buy that EMR

CCHIT, or the Certification Committee for Health Information Technology

This is the latest compilation of electronic medical records that meet the standards regarding functionality, and interoperability

CCHIT’s inspection process is a rigorous test of electronic health record (EHR) products using two methods: jury-observed demonstration and inspection of self-attestation materials.

To complete this testing, CCHIT empanels a team of three clinical jurors, one of whom must be a practicing physician, and an IT security evaluator to assess a product’s conformance to the CCHIT certification criteria. The inspection occurs by observing the performance of the applicant’s product in executing a series of test scripts and reviewing required materials supplied by the applicant.

Provider Jurors
Lee Barnhart, RN, ADN
Clinical Analyst
MD Buyline
Judy Boesen, RN, BGS, MAM
Colorado Otolaryngology Associates, PC
Dan Brewer, MD
Associate Professor
University of Tennessee
Teresita Bushey, MA, APRN-BC
Adult Nurse Practitioner, Nursing Faculty
College of St. Scholastica
Cherry, Bekaert & Holland, LLP
Chief Operating Officer
First Class Solutions, Inc.
Jennifer Garvin, PhD, MBA
Medical Informatics Postdoctoral Fellow
US Department of Veterans Affairs
Linda Hogan, PhD
VP, Clinical Informatics & Operations
Pittsburgh Mercy Health System
Doris Hubbs, MD
Kingsport Consultants
John Hummel
Clinical Solutions Director
Perot System Healthcare Group
Elisa Kogan, MS, CCS-P
Director, Physician Practice
University of Illinois Medical Center
Kent Maurer, BS, AAS, AAS
Sr. VP, Information Services and CIO
Cook Children's Health Care System
Susan Miller, RN, FACMPE
Family Practice Associates of Lexington, KY
Roseanne Moore, BSN, MBA
Director of Clinical Applications and Operations
GWU Medical Faculty Assoicates
Susan Ordway,
HIS Advisor - DOQ-IT Program
Douglas Peterson, MD
CMO; Chief, Correctional HIS,
State of California
Department of Corrections and Rehabilitation
Susan Postal, MBA, RHIA
Vice President
Health Information Management Systems
Hospital Corporation of America
Luis Adrian Rivera Pomales, MD, MBA, MPH,
Medical Director
PEB Corp.
Iris Spikes, RN, BS, MBA
Senior Systems Analyst
Health First
Angela Tiberio, MD
CMO; Associate Vice President
Rush University Medical Center

Physician Jurors
Kenneth Adler, MD, MMM
Medical Director of Information Technology
Arizona Community Physicians
Kenneth Bernstein, MD
Medical Director/Chief Medical Officer
Darin M. Camarena Health Centers, Inc.
Jennifer Brull, MD
President & CEO
Prairie Star Family Practice
H. Coren, MD
Nitin Damle, MS, MD, FACP
South County Internal Medicine, Inc.
Brian Foresman, DO, MS
Associate Professor of Clinical Medicine
Indiana University
Duane Gainsburg, MD
Neurological Surgery
Edward Gold, MD, MBA
Senior Partner
Old Hook Medical Associates, LLC
Patricia Hale, MD, PhD, FACP
Glen Falls Hospital
Ronald Hughes, MD
Family Physician
Mark D. Kaufmann, MD
Lawrence Kent, MD
Clinical Professor of Medicine
Case Western Medical School
Douglas Krell, MD
Ardent Health Systems
Andrew Lee, MD
Galion Community Hospital Physician Practice
Stephen Morgan, MD
Pediatric Associates of Greater Salem
Bruce Nelson, MD
Chief, Division of Basic and Clinical Immunology
Mission Internal Medical Group, Inc.
Stephen Newman, MD, MBA
Clinical Instructor
Robert Wood Johnson School
Daniel Shapiro, MD
Adjunct Associate Professor of Medicine,
Boston University School of Medicine
Lahey Clinic
Paul Ullom-Minnich, MD
Partners in Family Care
Robert White, MD, MPH
New Mexico VA Health Care System
Steven Zuckerman, MD
The following list is the current vendors who are compliant with the CCHIT standard.
(note: all links should be "clickable"

Key: Company (Product and version) Date of CCHIT Certified status

· ABELSoft Corporation (ABELMed PM - EMR 7.0) 10/23/2006
· AcerMed, Inc.(AcerMed 1.0) 10/23/2006
· Advanced Data Systems Corporation (MedicsDocAssistant 3.0) 1/29/2007
· AllMeds, Inc. (AllMeds EMR Version 7) 4/30/2007
· Allscripts (HealthMatics Electronic Health Record 2006) 7/18/2006
· Allscripts (TouchWorks Electronic Health Record 10.2.3) 7/18/2006
· athenahealth, Inc. (athenaClinicals 0.15) 4/30/2007
· BizMatics, Inc. (PrognoCIS 1.81) 4/30/2007
· BMD Services (E-Paperless Practice V2.01) 4/30/2007
· BML MedRecords Alert LLC (Physician's Solution 3.0) 4/30/2007
· Bond Technologies (Bond Clinician EHR 2006) 10/23/2006
· Business Computer Applications, Inc. (PEARL EMR 6.0) 4/30/2007
· Catalis (Accelerator Graphical Health Record 4.111) 1/29/2007
· Cerner Corporation (PowerChart 2005.02) 7/18/2006
· Community Computer Service (MEDENT 16) 7/31/2006
· Companion Technologies (Companion EMR v8.5) 7/18/2006
· CPSI (Medical Practice EMR 14) 10/23/2006
· CureMD Corporation (CureMD 9.0) 4/30/2007
· Department of Defense, Military Health System (AHLTA 3.3* **) 4/30/2007
· Document Storage Systems, Inc. (vxVistA V1.0) 4/30/2007
· eClinicalWorks (eClinicalWorks Version 7.0 Release 2) 7/18/2006
· eClinicalWorks (eClinicalWorks Version 7.5) 2/6/2007
· Eclipsys Corporation (Sunrise Ambulatory Care 4.5) 10/23/2006
· EHS (CareRevolution 5.0i) 10/23/2006
· e-MDs (e-MDs Solution Series 6.1) 7/18/2006
· eMedicalFiles, Inc. (MDAware® 2.2) 4/30/2007
· Encite (TouchChart 3.3) 1/29/2007
· Epic Systems (EpicCare Ambulatory EMR Spring 2006) 7/18/2006
· GE Healthcare (Centricity® EMR 2005 Version 6.0) 7/18/2006
· GE Healthcare (Centricity® Practice Solution Version 6.0) 3/28/2007
· Glenwood Systems, LLC (GlaceEMR 2.0**) 4/30/2007
· gloStream, Inc. (gloEMR 3.5) 4/30/2007
· Greenway Medical Technologies (PrimeSuite 2007) 10/23/2006
· Henry Schein Medical Systems (MicroMD EMR 4.5) 1/29/2007
· iMedica Corporation (iMedica Patient Relationship Manager 2005, version 5.1) 7/31/2006
· iMedica Corporation (iMedica Patient Relationship Manager 2006, version 6.0) 11/15/2006
· Infor-Med Corporation (Praxis® Electronic Medical Records, version 3.4) 7/31/2006
· InteGreat Concepts, Inc. (IC-Chart Release 6.0) 1/29/2007
· iSALUS Healthcare (OfficeEMR 2007) 4/30/2007
· JMJ Technologies (EncounterPRO® EHR 5.0) 7/18/2006
· LifeWatch Technologies, Inc. - A LifeWatch Corp Company (LifeT.I.M.E. (7.100)) 1/29/2007
· LSS Data Systems (Medical and Practice Management Suite Client Server Version 5.5 (ServiceRelease 2.1)) 7/31/2006
· LSS Data Systems (Medical and Practice Management (MPM) Suite MAGIC Version 5.5, Service Release 2.1) 1/29/2007
· Marshfield Clinic (CattailsMD Version 5*) 1/29/2007
· McKesson (Horizon Ambulatory Care Version 9.4) 7/18/2006
· MCS-Medical Communication Systems (mMD.Net EHR 9.0.9) 7/18/2006
· MDLAND (MDLAND Electronic Health Record and Practice Management Systems 8.0) 4/30/2007
· MDTablet (MDTABLET 2.6.7) 4/30/2007
· (MEDAZ 60720.001) 1/29/2007
· MedcomSoft (Record 2006 (V 3.0)) 7/18/2006
· Medical Informatics Engineering (WebChart 4.23) 7/18/2006
· Medical Messenger (Medical Messenger Astral Jet EMR 3.7.1) 4/30/2007
· Medicat (Medicat 8.8) 1/29/2007
· MedicWare (MedicWare EMR 7) 1/29/2007
· MedInformatix (MedInformatix V 6.0) 1/29/2007
· MediNotes Corporation (MediNotes e 5.0) 10/23/2006
· Meditab Software (Intelligent Medical Software (IMS) 2007) 1/29/2007
· MedPlexus, Inc. (MedPlexus EHR 8.5) 10/23/2006
· meridianEMR, Inc. (meridianEMR 3.6.1) 4/30/2007
· Misys Healthcare Systems (Misys EMR 8.0) 7/18/2006
· NCG Medical Systems, Inc. (dChart EMR 4.5) 2/9/2007
· Netsmart Technologies (Avatar PM 2006 Release 02) 10/23/2006
· NextGen Healthcare Information Systems (NextGen EMR 5.3) 7/18/2006
· Nightingale Informatix Corporation (myNightingale Physician Workstation 5.1) 7/18/2006
· Noteworthy Medical Systems, Inc.(Noteworthy EHR 5.4) 10/23/2006
· OmniMD (OmniMD EMR 6.0.5) 4/30/2007
· Partners HealthCare System, Inc. (Longitudinal Medical Record (LMR) 5.1.1*) 4/30/2007
· Point and Click Solutions, Inc. (OpenChart 8.0**) 4/30/2007
· Polaris Management, Inc. (EpiChart 5.2**) 4/30/2007
· PowerMed Corporation (Practice Suite Version 2) 4/30/2007
· Practice Partner (Practice Partner 9) 7/18/2006
· Practice Partner (Practice Partner 9.1) 11/18/2006
· Practice Partner (Practice Partner 9.2) 3/7/2007
· Prime Clinical Systems, Inc. (Patient Chart Manager 5.3) 4/30/2007
· ProPractica Inc.(Streamline MD 9.0.9) 10/23/2006
· Pulse Systems (Pulse Patient Relationship Management 3.1.1) 1/29/2007
· Sage Software(Intergy EHR by Sage v3.00) 7/18/2006
· Sage Software (Intergy EHR by Sage v3.50) 10/20/2006
· Sequel Systems, Inc. (SequelMed EMR V7.50) 4/30/2007
· Spring Medical Systems (SpringCharts EHR 9.0) 1/29/2007
· SSIMED (Emrge 6.0 Release 1.0) 1/29/2007
· SynaMed, LLC (SynaMed EMR 5.487) 4/30/2007
· Universal Software Solutions (VersaSuite 7.5) 1/29/2007
· UNI/CARE Systems, Inc. (Pro-Filer 2007.0.0) 4/30/2007
· Utech Products, Inc. (Endosoft 4/30/2007
· Visionary Medical Systems (Visionary Dream EHR 7.1) 1/29/2007
· Waiting Room Solutions (Waiting Room Solutions Practice Management System 3) 4/30/2007
·, LLC (Workflow EHR 2.1) 4/30/2007
· WorldVistA (WorldVistA EHR VOE/ 1.0) 4/30/2007

Choose CCHIT CertifiedSM Products
CCHIT is the recognized certification authority in the United States for EHR products - an independent, private-sector organization that sets the Gold Standard for EHRs.
A CCHIT CertifiedSM seal assures you that an EHR product meets basic requirements for:
· functionality (ability to carry out specific tasks)
· interoperability (compatibility with other products) and
· security (ability to keep your patients' information safe)
CCHIT works with all its stakeholders to gain consensus on certification criteria and testing processes related to the industry standards produced by healthcare standards development organizations (SDOs). Certification is a mechanism for enhancing the confidence and orderliness of the HIT marketplace. The inspection and testing process performed when certifying HIT products is based on agreed-upon standards, as well as unbiased inspection and/or testing.
Certification for ambulatory EHR products is available in 2006; inpatient EHR products will follow in 2007. CCHIT’s certification criteria and processes are created and piloted with physician input. CCHIT’s product test teams include three clinically experienced jurors, one of which must be a physician.
Get more information: CCHIT exhibits and presents at healthcare and medical meetings, and hosts public Town Halls and Town Calls. CCHIT eNews keeps you up-to-date on all CCHIT announcements and activities. CCHIT shares case studies from its broad stakeholder community.
Find CCHIT CertifiedSM EHRs: Look for certified products or ask vendors when they plan to certify their products.
Email CCHIT. © 2007 Certification Commission for Healthcare Information Technology Privacy Policy Terms of Use
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Information compiled 05/08/2007 Gary M. Levin M.D. Regional Coordinator IERHIO

Monday, May 7, 2007

in Memoriam--Ron Bassanger M.D.

Prominent doctor dies at 57Redlands Daily Facts - 05/05/2007, 06:41 am: Dr. Ron Bangasser, a physician known locally and nationally for his compassion for patients and his zeal to improve the quality of health care, died of cancer May 2 in Redlands. He was 57... "Ron's death is a tremendous loss to all of us - his family, his patients, his friends and colleagues and all of medicine," said Dr. Anmol S. Mahal, president of the California Medical Association. "Ron was always an example of what a doctor should be, operating his wound care clinic, his practice, treating patients in the hospital, all the while serving his patients and colleagues through his advocacy for the California Medical Association."

Dr Bassanger was on the charter committee of the Inland Empire RHIO. He was a visionary in regard to the importance of HIE and EMRs. We shall all miss his wisdom.

Gary Levin MD

Tuesday, May 1, 2007

Will Patients select their MD according to Who Has an EMR??

Although I was unable to attend the Consumer Directed Health Care Conference in Las Vegas t his past week (CDHCC) I have been able to follow some important information published on their web site.

Another Reason to Adopt Electronic Medical Recordsby Scott MacStravic
April 30, 2007 at 9:40 pm · Filed under Health IT

A recent Accenture survey found that two-thirds of consumers responding indicated that having an EMR system or not played a role in their selection of a physician. Moreover, a little over half of these consumers said that they would be willing to pay a reasonable extra amount to cover the costs of such a system. Despite this consumer preference, only about 10% of practices and 25% of doctors have EMR systems in place. The cost of implementing and maintaining the system is the overwhelming barrier, with 86% of physicians reporting that as a concern. [“Survey Finds Patients Favor Doctors Using EMRs” E-Health Trend Watch Apr 27, 2007 (]
This consumer attitude adds to the many quality and efficiency reasons for physicians to adopt EMR systems. Fortunately, governments, employer coalitions, and hospitals are indicating a willingness to support physicians’ efforts to digitalize their records systems, and laws against hospitals helping are being relaxed. But another reason emerged in a breakout presentation at the World Healthcare Congress this week.
During the presentation of Regence BlueCross BlueShield and the software firm, Kryptiq Corporation, both in the Northwest, the preference of at least that employer for physician practices with EMR systems was made clear. This makes good business sense for Kryptiq, since it is in the software business, but also because of the advantages the EMRs offer in employee health management.
Almost all the current pressure on physicians to adopt EMR systems focuses on their importance in sickness care. They enable physicians to more quickly access information needed to diagnose and treat patients who are ill, to avoid duplication of tests in making diagnoses, and avoid contraindicated medications in treatment, for example. They also facilitate coding and billing, so help practices in managing cash flow.\
Growing importance is being given to the prospect of sharing EMR information across practices, to improve continuity of care when multiple practices are involved in an episode of care, for example. Regional Health Information Organizations are emerging as ways to enable sharing of data by practices when patients seek care away from their usual sources, perhaps in emergencies such as hurricane Katrina.
But EMRs are also excellent foundations for health management, for preventing and catching early risks and diseases that can be managed in ways that reduce direct sickness care costs, but also worker absences, impaired performance while at work (“presenteeism”), disability wage replacement costs and other labor costs to employers. And employers can influence the physician selection of hundreds, even thousands of employees.
Kryptiq considers the presence of EMRs in deciding which physician practices to include in its provider network, for example, and selected GreenField Health System in Portland, OR as a partner in its effort to manage the health of its employees, not simply deliver sickness care. The founder of GreenField Health serves on the Kryptiq board, while GreenField is also a customer for Kryptiq’s secure online communications system for communicating with patients. Such communications improve the efficiency of practices by eliminating unnecessary office visits, while providing the foundation for ongoing health improvement and maintenance efforts.
In addition to using EMRs as one factor in choosing practices for provider networks, employers can use EMR-enabled performance data on how well practices are doing in managing employee health to inform individual employee choices of personal physicians. When employee performance makes a difference to their compensation and career prospects, and health has a significant impact on their performance, this adds another reason for patients to prefer physicians with EMRs.
My comment

This is obviously a biased survey, since it was performed by businesses that stand to gain from IT adoption.