Google Health (GH) could be the event of the decade in advancing health care reform — not just healthcare information technology (HIT) reform,
The "ultimate" PHR????
Google Health (GH) could be the event of the decade in advancing health care reform — not just healthcare information technology (HIT) reform, but health care system reform. GH promises simultaneously to create AND dominate the market for next generation personal health records (PHRs). There is nothing else in our solar system or in the entire universe like it.
II. GH’s Anticipated Technology Model
We’ve been provided a number of clues about the technology model that GH is likely to develop:
Patient centric
A personal health URL
Automated data mechanisms to gather and store PHI
Interoperable technical standards: XML and the Continuity of Care Record (CCR) standard
A user interface
Appropriate security and confidentiality measures
Value added functionality (over time)
What do you think???
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Tuesday, July 3, 2007
Sunday, June 24, 2007
THE GLOSSARY
My apologies for the delay in getting this posted. It is a rather long one, but contains a lof of information for "newbies" I suggest you copy and paste it into a word document.....then if you have google desktop you can search for "glossary".
GLOSSARY
Access:
The process of obtaining data from, or placing into a computer system or storage device. It refers to such actions by any individual or entity who has the appropriate authorization for such actions.
American National Standards Institute (ANSI):
ANSI is a broad based agency charged with overseeing voluntary standards development for everything from computers to household products. ANSI accredits standards development organizations (SDO) based on their consensus process, then reviews and officially approves the SDO recommendations.
American Society for Testing and Materials (ASTM):
American Society for Testing and Materials develops standards on characteristics and performance of materials, products, systems, and services. There are numerous standards-writing technical committees. E31 is the Committee on Computerized Systems and E31.28 is the subcommittee on Healthcare Informatics responsible for the Continuity of Care (CCR) standard.
Annual Support & Maintenance:
Costs that are typically 15-20% of the software license costs. Where the actual license is normally a one- time fee, the support and maintenance costs are renewed on a yearly basis. This yearly fee basically covers two areas: 1) any upgrades or new releases; and 2) customer service and support. It should be noted that both vendor EHR software and third party software will need support, so it is important to determine which components the support costs cover. Also, some vendors might have more than one service level agreement representing different support options at different costs.
Architecture:
The orderly arrangement of parts; structure.
ASTM:
See American Society for Testing and Materials.
Asymmetric Key System:
A system that uses different keys for encryption and decryption. Within such a system, it is computationally infeasible to determine the decryption key (which is kept private) from the encryption key (which is made publicly available).
Attribute:
A characteristic or property.
Audit trail:
Chronological record of system activity which enables the reconstruction of information regarding the creation, distribution, modification, and deletion of data.
Authentication:
Verification of the identity of a person or process.
Authorization: The role or set of permissions for information system activity assigned to an individual.
Biometric Authentication Technology:
Technology that uses some human biological feature (e.g. fingerprint, voice pattern, retina scan, or signature dynamics) to uniquely identify an individual.
CA (certification authority):
The entity providing third party trust within PKI.
Certification/Conformance Testing: Testing a product for the existence of specific features, functions, or characteristics required by a standard in order to determine the extent to which that product satisfies the standard requirements.
Chief Complaint Mapper: A software product that maps chief complaints, captured as text, and transforms them into useful digital data that can be used in functions such as public health outbreak surveillance.
Clinical Classification:
A method of grouping clinical concepts in order to represent classes that support the generation of indicators of health status and health statistics.
Clinical Data Repository: The data warehouse that contains clinical data (HL7 messages) centrally.
Clinical Messaging:
The communication among providers involved in the care process that can range from real time communication (for example, fulfillment of an injection while the patient is in the exam room), to asynchronous communication (for example, consult reports between physicians). Reference: Health Level Seven, Inc.
"HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp)
Clinical Messaging #1:
Continuity of Care Data Exchanges
(Inter-Provider Communication):
Communication among providers involved in the care process can range from real time communication (for example, fulfillment of an injection while the patient is in the exam room), to asynchronous communication (for example, consult reports between physicians). Some forms of inter-practitioner communication will be paper based and the EHRS must be able to produce appropriate documents. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp)
Clinical Messaging #2:
Secure Patient/Physician e-mail (Provider and Patient or Family Communication): Trigger or respond to electronic communication (inbound and outbound) between providers and patients or patient representatives with pertinent actions in the care process. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004.
Clinical Reminders (Clinical Guideline Prompts):
The ability to remind clinicians to consider certain actions at a particular point in time, such as prompts to ask the patient appropriate preventive medicine questions, notifications that ordered tests have not produced results when expected, and suggestions for certain therapeutic actions, such as giving a tetanus shot if one has not been given for 10 years. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative Foundation, 2005.
Clinical User Authentication:
The process used by the HIE to determine the identity of the person accessing the system with adequate certainty to maintain security and confidentiality of personal health information and to administer with certainty of identity a regulated process such as e-prescribing and chart signing.
Computerized Provider Order Entry (CPOE): A computer application that allows a physician's orders for diagnostic and treatment services (such as medications, laboratory, and other tests) to be entered electronically instead of being recorded on order sheets or prescription pads. The computer compares the order against standards for dosing, checks for allergies or interactions with other medications, and warns the physician about potential problems. Reference: United States Department of Health and Human Services. Office of the National Coordinator for Health Information Technology (ONC) Glossary: http://www.hhs.gov/healthit/glossary.html.
Confidentiality:
A 3rd party's obligation to protect the personal information with which it has been entrusted.
Controlled Clinical Vocabulary: A system of standardizing the terms used in describing client-centered health and health service-related concepts.
Conversion Services:
Consulting services offered by the vendor. These services will take your original data, either in paper or electronic form, and transfer the data into the EHR system database.
Data Center:
The physical space and hardware used by the HIE to house its operations if these assets are kept within the HIE.
Data Integrity:
The accuracy and completeness of data, to be maintained by appropriate security measures and controls. Preservation of the original quality and accuracy of data, in written or in electronic form.
Data Recovery Services:
A mechanism and process to safely store duplicate databases and recreate the data should a disaster occur.
Decision Support:
Computerized functions that assist users in making decisions in their job functions. In the practice of medicine, these functions include providing electronic access to medical literature, alerting the user to potential adverse drug interactions, and suggesting alternative treatment plans for a certain diagnosis.
Decryption:
The technique of using mathematical procedures to "unscramble" data so that an unintelligible (encrypted) message becomes intelligible.
Demographics: Information about name, address, age, gender, and role used to link patient records from multiple sources in the absence of a unique patient identifier.
DICOM (Digital Imaging Communications in Medicine): A standard which defines protocols for the exchange of medical images and associated information (such as patient identification details and technique information) between instruments, information systems, and health care providers. It establishes a common language that enables medical images produced on one system to be processed and displayed on another.
Digital Signature:
A string of binary digits which is computed using an encryption algorithm. Digital signatures enable signatory authentication, confirmation of data integrity, and non-repudiation of messages.
Doctor Matching:
The process of cross-linking the multiple provider identifiers in a community from a variety of provider identifier sources and creating a master doctor identifier with a key for cross-referencing the various community identifiers.
Document Review, Edit, Sign:
A software process that allows for the secure review, editing, and signature through electronic, distributed technology of electronic health record components, such as operative reports, discharge summaries, and consultations.
eLaboratory:
The electronic delivery of laboratory results to practices so that such data may be integrated into electronic patient records in a full EHR system, or used by a dedicated application to view structured, context-rich, and/or longitudinal laboratory results on a patient. eLaboratory includes closing the orders loop, documenting the review of results by clinicians, and documenting that the results have been communicated to the patient. The full benefits of eLaboratory are not achieved until the results are used as input into clinical decision support systems (CDSS).
Electronic Billing (Claims, Eligibility, Remittance):
The ability to contact the payer before the patient is seen and get a response that indicates whether or not the services to be rendered will be covered by the payer. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative, 2005.
Electronic Billing Support:
The ability to contact the payer before the patient is seen and get a response that indicates whether or not the services to be rendered will be covered by the payer. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based HIE Initiatives and Organizations." Washington: eHealth Initiative Foundation, 2005.
Electronic Health Record: Electronically maintained information about an individual's lifetime health status and health care.
Electronic Imaging Results Delivery:
The ability to accept messages from radiology sources and integrate the data for presentation to a clinician. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations. " Washington: eHealth Initiative Foundation, 2005.
Electronic Prescribing (Pharmacy Communication):
Provides features to enable secure bidirectional communication of information electronically between practitioners and pharmacies or between practitioner and intended recipient of pharmacy orders. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp
Electronic Quality Data Submission (Performance and Accountability Measures): Support the capture and reporting of quality, performance, and accountability measures to which providers/facilities/delivery.
Electronic Referral Management:
The ability to generate and/or receive summaries of relevant clinical information on a patient that are typically transferred between healthcare providers when a patient is referred to a specialist or admitted or discharged from a hospital. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative Foundation, 2005.
Electronic Referrals and Authorizations:
The ability to generate and/or receive summaries of relevant clinical information on a patient that are typically transferred between healthcare providers when a patient is referred to a specialist or admitted or discharged from a hospital. Reference: eHI Foundation. "Second Annual Survey of State, Regional and Community-based HIE Initiatives and Organizations. " Washington: eHealth Initiative Foundation, 2005.
Electronic Signature:
A digital signature, which serves as a unique identifier for an individual. Reference:
Encryption: The process of enciphering or encoding a message so as to render it unintelligible without a key to decrypt (unscramble) the message.
E-Prescribing: Provides features to enable secure bidirectional communication of information electronically between practitioners and pharmacies or between practitioner and intended recipient of pharmacy orders. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp
Health Information Exchange (HIE): The mobilization of healthcare information electronically across organizations within a region or community.
HIE provides the capability to electronically move clinical information between disparate healthcare information systems while maintaining the meaning of the information being exchanged. The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care.
Formal organizations are now emerging to provide both form and function for health information exchange efforts. These organizations (often called Regional Health Information Organizations, or RHIOs) are ordinarily geographically-defined entities which develop and manage a set of contractual conventions and terms, arrange for the means of electronic exchange of information, and develop and maintain HIE standards.
Although HIE initiatives differ in many ways, survey results and eHI experiences with states, regions and communities indicate that those who are experiencing the most success share the following characteristics. They are:
Governed by a diverse and broad set of community stakeholders;
Develop and assure adherence to a common set of principles and standards for the technical and policy aspects of information sharing, addressing the needs of every stakeholder;
Develop and implement a technical infrastructure based on national standards to facilitate interoperability;
Develop and maintain a model for sustainability that aligns the costs with the benefits related to HIE; and
Use metrics to measure performance from the perspective of: patient care, public health, provider value, and economic value.
Reference: eHealth Initiative. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative, 2005.
Health Care Interoperability:
Assures the clear and reliable communication of meaning by providing the correct context and exact meaning of the shared information as approved by designated communities of practice. This adds value by allowing the information to be accurately linked to related information, further developed and applied by computer systems and by care providers for the real-time delivery of optimal patient care.
Health Level Seven (HL7): An ANSI approved American National Standard for electronic data exchange in health care. It enables disparate computer applications to exchange key sets of clinical and administrative information.
ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th Revision): The 1992 revision of the international disease classification system developed by the World Health Organization.
ICD-10-CM (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification): The American modification of the ICD-10 classification system, for field review release in 1998.
ICD-10-PCS (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Procedural Classification System): A classification system for reporting clinical procedures, to accompany ICD-10-CM, developed in the US, for 1998 field review release.
ICD-9 (International Classification of Disease, 9th Revision): The 1972 revision of the international disease classification system developed by the World Health Organization.
ICD-9-CM (International Classification of Disease, 9th Revision, Clinical Modification): The American modification of the ICD-9 classification system for both diagnoses and procedures.
Implementation Services: Consulting services offered by the vendor. These services will provide planning and actual implementation of an EHR system. It is important when comparing quoted implementation costs that physicians understand which detailed cost line items a particular vendor will be supplying. Also, make sure and take a look at their project plans.
Informatics: The application of computer science and information science to the management and processing of data, information, and knowledge.
Interface: Shared boundary between two functional units defined by various characteristics pertaining to the functions, physical interconnections, signal changes, and other characteristics as appropriate.
Interface to ADT System: The interface between an HIE and the systems that are sources for admission, discharge and transfer (ADT) of patients in the care delivery setting and that are resident within care delivery institution.
Interface to ASP EHR System: The interface between an HIE and Electronic Health Records (EHRs) that are maintained on ASP platforms (i.e. NexGen, AllScripts).
Interface to Claims System: The interface between an HIE and the systems that are sources for or routing pathways for claims data that are resident within health plans and claims clearinghouses.
Interface to EKG System: The interface between an HIE and the systems that are sources for EKG results that are resident within dispensing physician offices and hospitals.
Interface to Eligibility System: The interface between an HIE and the source data of which people have eligibility for which type of benefits that are resident within health plans and are not infrequently web-enabled.
Interface to Formulary System: The interface between an HIE and the systems that are sources for formulary status of specific drugs for specific health benefit designs and that are resident within pharmacy benefit management companies and hospitals.
Interface to Laboratory System: The interface between an HIE and systems that are sources of laboratory data.
Interface to Pharmacy System: The interface between an HIE and the systems that are sources for prescription data or that are resident within dispensing pharmacies, pharmacy benefit management companies and hospitals.
Interface to Practice Management System: The interface between an HIE and the systems that are sources for the financial management systems of physician practices.
Interface to Provider List System: The interface between an HIE and the systems that track the multiple providers and their identifying data that are resident within health plans, dispensing pharmacies, pharmacy benefit management companies laboratories, physician practices, and hospitals.
Interface to Provider Office EHR System: The interface between an HIE and EHRs that are maintained in practice-specific systems (e.g. EPIC).
Interface to Radiology System: The interface between an HIE and systems that are sources for radiological data.
Interface to Transcribed Reports System: The interface between an HIE and the systems that are sources for transcribed reports. Typically these systems are based at a transcription service or at a hospital and contain admission and discharge notes and consultations, operative reports, and pathology and radiology results.
Interoperability:
The ability of two or more systems or components to exchange information and to use the information that has been exchanged accurately, securely, and verifiably, when and where needed.
The International Organization for Standardization (ISO): It is a worldwide federation of national standards bodies from some 130 countries, one from each country. ISO's work results in international agreements which are published as International Standards.
Key Certificate: A data record that authenticates the owner of a public key for an asymmetric algorithm. It is issued by a certification authority and is protected by a digital signature allowing the certificate to be verified widely. The certificate may also contain other fields beside the value to the key and the name of the owner, for example an expiration date.
Keys: A sequence of symbols that controls the operations of encryption and decryption.
LOINC (Logical Observation Identifiers, Names, and Codes): The LOINC databases provide sets of universal names and ID codes for identifying laboratory and clinical test results. The purpose is to facilitate the exchange and pooling of results, such as blood hemoglobin, serum potassium, or vital signs, for clinical care, outcomes management, and research.
Medication Matching: The process of cross-linking the multiple possible medication identifiers naming conventions in a community from a variety of systems housing medication information and creating a master medication identifier with a key for cross-referencing the various community identifiers. For example there are hundreds of NDC codes for identical drugs as well as HCPCS codes that identify the same drug as NDC codes.
Medication Reconciliation: Alerts providers in real-time to potential administration errors such as wrong patient, wrong drug, wrong dose, wrong route and wrong time in support of medication administration or pharmacy dispense/supply management and workflow. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp
Message Integrity: Protecting a message against its unauthorized modification, often by the originator of the message generating a digital signature.
Messaging to Pharmacies: The process of communicating electronically with pharmacies. This typically includes the cost of communication lines and processes between the HIE and pharmacies. This is necessary to support the e-prescribing function when that function includes the process of electronically sending a digital prescription to the pharmacy.
Messaging to Providers: The process of communicating electronically with providers. This typically includes the cost of communication lines and processes between the HIE and provider terminals.
National Health Information Network: An interoperable, standards-based network across the nation for the secure exchange of heath care information. Reference: HHS Awards Contracts to Develop Nationwide Health Information Network. 2005.
Network Connectivity: The process used for maintaining connection for communication between the HIE and a data source (laboratory, radiology practice, physician practice, or hospital) and data user (physician practice or hospital).
Network: A set of connected elements. For computers, any collection of computers connected together so that they are able to communicate, permitting the sharing of data or programs.
Order Entry: The process of communicating health care provider orders through electronic, computerized processes.
OSI (Open Systems Interconnection): An international standard for networking adopted by the ISO (International Organization for Standardization). This 7-layer model offers the widest range of capabilities for networking.
Outbreak Surveillance: Support clinical health state monitoring of aggregate patient data for use in identifying health risks from the environment and/or population. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp
Parallel Pathways for Quality Healthcare: eHI has developed a set of principles and framework for alignment of incentives with both quality and efficiency goals as well as HIT capabilities within the physician practice and health information exchange capabilities across markets. This Framework—entitled “Parallel Pathways for Quality Healthcare” offers significant guidance to states, regions and communities who are exploring health information exchange as a foundation to address quality, safety and efficiency challenges.
Participant Roles: Examples of roles that may be recognized by the health system that participate in events affecting the health of people:
Provider
Governor
Manager
Recipient
Researcher
Educator
Worker
Family Member
Roles may be used to authorize an individual's access to information system functionality.
Patient Matching: The process of cross-linking the multiple patient identifiers in a community from a variety of patient identifier sources and creating a master patient identifier with a key for cross-referencing the various community identifiers. This is also referred to as a record locator service.
Pay-for-Performance/Quality Data Reporting: Supports the capture and reporting of quality, performance, and accountability measures to which providers/ facilities/ delivery systems/communities are held accountable including measures related to process, outcomes, and/or costs of care, may be used in 'pay for performance' monitoring and adherence to best practice guidelines. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp
Record (PHR): An electronic application through which individuals can maintain and manage their health information (and that of others for whom they are authorized) in a private, secure, and confidential environment. Reference: United States Department of Health and Human Services. Office of the National Coordinator for Health Information Technology (ONC) Glossary: http://www.hhs.gov/healthit/glossary.html. 2005
Public Key Infrastructure (PKI): A conceptual framework that enables the encryption, decryption and electronic "signing" of data transmissions in a secure fashion within an open network environment.
Privacy: Right of an individual to control the circulation of information about him-/herself within social relationships; freedom from unreasonable interference in an individual's private life; an individual's right to protection of data regarding him/her against misuse or unjustified publication.
Private Key: In asymmetric cryptography, the key which is held only by the user for signing and decrypting messages.
Public Health Outbreak Surveillance: Supports clinical health state monitoring of aggregate patient data for use in identifying health risks from the environment and/or population.
Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp
Public Health Processor: A software product that processes extracted data from health care provider systems for the purpose of tracking, trending, and reporting for public health reasons.
Public Key Certificate: A data record that authenticates the owner of a public key for an asymmetrical key system. It is issued by a CA and is protected by a digital signature, allowing the certificate to be verified widely.
Public Key: In asymmetric cryptography, the key which is published by the user to encrypt messages and so that others may verify his/her signature.
Recommend Treatment and Monitoring: The basis of cost, local formularies or therapeutic guidelines and protocols. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp
Registration Authority: An entity (group or agency) that has been delegated by a CA to perform a specific set of ‘trusted authority’ functions within PKI.
Results Answer Matching: The process of cross-linking the multiple possible answers to asking for a given result. For instance, asking for the results of a chest x-ray could yield a dictated report or a digital image of an x-ray. In any case, the case received must be matched across the type of result to a term identifying a common result.
Results Name Matching: The process of cross-linking the multiple possible names of data results that can contain the same information. For instance a blood glucose reading can be called up by a blood glucose test, an SMA panel, or a glucometer result.
Results Review (Alerts to Providers): The ability to interpret the clinical data that is entered about a patient using a set of rules or algorithms which will generate warnings or alerts at various levels of severity to a clinician. These are intended to make the clinician aware of potentially harmful events, such as drug interactions, patient allergies, and abnormal results that may affect how a patient is treated, with the intention of speeding the clinical decision process while reducing medical errors. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative Foundation, 2005.
Results Review: The ability to interpret the clinical data that is entered about a patient using a set of rules or algorithms which will generate warnings or alerts at various levels of severity to a clinician. These are intended to make the clinician aware of potentially harmful events, such as drug interactions, patient allergies, and abnormal results, which may affect how a patient is treated, with the intention of speeding the clinical decision process while reducing medical errors.
Risk Assessment: An evaluation of the chance of vulnerabilities being exploited based on the effectiveness of existing or proposed safeguards or countermeasures.
Risk: The chance of a vulnerability being exploited.
Rules Engine: A set of rules defined within a software process that converts clinical and administrative data streams into a meaningful representation of clinical quality markers to be used in functions such as pay for performance/quality data reporting.
Security: In information systems, the degree to which data, databases, or other assets are protected from exposure to accidental or malicious disclosure, interruption, unauthorized access, modification, removal or destruction.
Service Level Agreement-Compliance: A documented track record of how well the vendor is meeting it’s customer support commitments.
Service Level Agreement-Customer Responsibilities and Duties: The steps that the customer needs to take in order to ensure that the vendor has all the information they need to resolve an issue.
Service Level Agreement-Hours of Support: Methods that will be used for communicating and resolving issues. Typical methods are email, phone, and online chat. Ask whether remote diagnostics and/or on site visits by support analysts are available.
Service Level Agreement-Methods of Support: Will be used for communicating and resolving issues. Typical methods are email, phone, and online chat. Remote diagnostics can be available and, in some instances, it might be necessary to have a support analyst come on site.
Service Level Agreement-Problem Escalation & Triage: The mechanism that defines how a problem migrates through the support system and the different resources that get involved along the way. If a problem can’t be resolved in a certain amount of time, then it escalates until it is resolved.
Service Level Agreement-Response Times: Different functions of the system might warrant different response times based on severity level. There should be a schedule of response times for different types of problems, and the service level agreement should define this accountability.
Service Level Agreement-Severity/Priority Classification: Different types of problems have different levels of urgency and importance. The severity level of a problem is usually noted when a support ticket is opened up. Resolution guarantees are based on severity levels. For example, CPOE down would be a high severity level while a patient education database not working might be a lower level of severity.
SNOMED International: A nomenclature for use by all health services professionals developed in the US and updated at least semi-annually.
Stages of Health Information Exchange Development:
Stage One:
Recognition of the need for HIE among multiple stakeholders in your state, region, or community
Stage Two:
Getting organized by defining shared vision, goals, & objectives, identifying funding sources, and setting up legal & governance structures
Stage Three:
Transferring vision, goals, & objectives to tactics and business plan, defining needs and requirements and securing funding
Stage Four:
Well under-way with implementation – technical, financial, and legal
Stage Five:
Fully operational health information organization. Transmitting data that is being used by healthcare stakeholders Sustainable business model.
Stage Six:
Demonstration of expansion of organization to encompass a broader coalition of stakeholders than present in the initial operational model
Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative Foundation, 2005.
Standard:
Documented agreements containing technical specifications or other precise criteria to be used consistently as rules, guidelines, or definitions of characteristics to ensure that materials, products, processes, and services are fit for their purpose. A standard* specifies a well defined approach that supports a business process and:
Has been agreed upon by a group of experts
Has been publicly vetted
Provides rules, guidelines, or characteristics
Helps to ensure that materials, products, processes and services are fit for their intended purpose
Available in an accessible format
Subject to ongoing review and revision process
*This differs from the healthcare industry's traditional definition of "standard of care."
Statistical Deviation Detector:
Identifies variances from patient-specific and standard care plans, guidelines, and protocols.
The International Organization for Standardization (ISO): It is a worldwide federation of national standards bodies from some 130 countries, one from each country. ISO's work results in international agreements which are published as International Standards.
Third Party-EHR Specific:
Applications that are essential to the basic infrastructure of the system. They are the building blocks, such as the technical platform upon which the EHR system is built (e.g.,Windows, Linux, or MacIntosh, etc.) Also what kind of database structure controls the system (e.g, SQL, Oracle, etc.). When comparing license costs, note if there are separate general system license costs or if these are rolled into the main cost. Also, ask whether there will be additional costs when the vendor upgrades their software and it becomes necessary to install a new version of the database or operating system. Make sure your infrastructure software will support any features you wish to add later on.
Third Party-General System: Applications that are essential to the basic infrastructure of the system. They are the building blocks such as the technical platform the EHR system is built on such as, Windows, Linux, or MacIntosh, etc. Also what kind of database structure controls the system – SQL, Oracle, etc. When comparing license costs note if there are separate general system license costs or if these are rolled into the main cost. Also, will there be additional costs when the vendor upgrades their software and it is necessary to install a new version of the database or operating system. Make sure your infrastructure software will support any features you wish to add later on.
Training Services:
Consulting services offered by the vendor. They provide hands on training for all aspects of the system.
UMLS (Unified Medical Language System):
A long-term research project developed by the US National Library of Medicine to assist health professionals and researchers to retrieve and integrate clinical vocabularies from a wide variety of information sources. The goal is to link information from scientific literature, patient records, factual databases, knowledge-based expert systems, and directories of institutions and individuals in health and health services.
Vendor Software Licenses: License cost of various modules. Typically, modules will be licensed on a concurrent or named user basis. For example, with a concurrent license, if there are 4 providers and 8 employees, a minimum of 12 concurrent licenses would be needed. However, if the providers were halftime [meaning, they only used the system half time] (and all 4 never used the system at any one time, only 10 licenses would be needed). If using a named user license under the same circumstances, 12 licenses would always be needed – as licenses are not shared among different people. There can be a provision though for “active” and “inactive” providers (which means they could look at information, but not enter it in the system). Under an ASP (monthly rental agreement), software licenses are not being purchased, but rented However, the same issues exist for determining number of ASP licenses as with a license purchase.
X12:
A committee chartered by the American National Standards Institute (ANSI) to develop uniform standards for inter-industry electronic interchange of business transactions—electronic data interchange (EDI).
X12N:
The principle responsibilities of ASC X12N Insurance Subcommittee are development and maintenance of X12 standards, standards interpretations, and guidelines for the insurance industry, including health insurance. Most electronic transactions regarding health insurance claims are conducted using these standards, many of which are mandated by HIPAA.
The website development and some of the content in the Toolkit have been made possible by grant number 1D1BTM00095-01 and 02, through the Health Resources and Services Administration HRSA Office of the Advancement of Telehealth (HRSA/OAT). The contents are solely the responsibility of the authors and do not necessarily represent the official view of HRSA/OAT.
GLOSSARY
Access:
The process of obtaining data from, or placing into a computer system or storage device. It refers to such actions by any individual or entity who has the appropriate authorization for such actions.
American National Standards Institute (ANSI):
ANSI is a broad based agency charged with overseeing voluntary standards development for everything from computers to household products. ANSI accredits standards development organizations (SDO) based on their consensus process, then reviews and officially approves the SDO recommendations.
American Society for Testing and Materials (ASTM):
American Society for Testing and Materials develops standards on characteristics and performance of materials, products, systems, and services. There are numerous standards-writing technical committees. E31 is the Committee on Computerized Systems and E31.28 is the subcommittee on Healthcare Informatics responsible for the Continuity of Care (CCR) standard.
Annual Support & Maintenance:
Costs that are typically 15-20% of the software license costs. Where the actual license is normally a one- time fee, the support and maintenance costs are renewed on a yearly basis. This yearly fee basically covers two areas: 1) any upgrades or new releases; and 2) customer service and support. It should be noted that both vendor EHR software and third party software will need support, so it is important to determine which components the support costs cover. Also, some vendors might have more than one service level agreement representing different support options at different costs.
Architecture:
The orderly arrangement of parts; structure.
ASTM:
See American Society for Testing and Materials.
Asymmetric Key System:
A system that uses different keys for encryption and decryption. Within such a system, it is computationally infeasible to determine the decryption key (which is kept private) from the encryption key (which is made publicly available).
Attribute:
A characteristic or property.
Audit trail:
Chronological record of system activity which enables the reconstruction of information regarding the creation, distribution, modification, and deletion of data.
Authentication:
Verification of the identity of a person or process.
Authorization: The role or set of permissions for information system activity assigned to an individual.
Biometric Authentication Technology:
Technology that uses some human biological feature (e.g. fingerprint, voice pattern, retina scan, or signature dynamics) to uniquely identify an individual.
CA (certification authority):
The entity providing third party trust within PKI.
Certification/Conformance Testing: Testing a product for the existence of specific features, functions, or characteristics required by a standard in order to determine the extent to which that product satisfies the standard requirements.
Chief Complaint Mapper: A software product that maps chief complaints, captured as text, and transforms them into useful digital data that can be used in functions such as public health outbreak surveillance.
Clinical Classification:
A method of grouping clinical concepts in order to represent classes that support the generation of indicators of health status and health statistics.
Clinical Data Repository: The data warehouse that contains clinical data (HL7 messages) centrally.
Clinical Messaging:
The communication among providers involved in the care process that can range from real time communication (for example, fulfillment of an injection while the patient is in the exam room), to asynchronous communication (for example, consult reports between physicians). Reference: Health Level Seven, Inc.
"HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp)
Clinical Messaging #1:
Continuity of Care Data Exchanges
(Inter-Provider Communication):
Communication among providers involved in the care process can range from real time communication (for example, fulfillment of an injection while the patient is in the exam room), to asynchronous communication (for example, consult reports between physicians). Some forms of inter-practitioner communication will be paper based and the EHRS must be able to produce appropriate documents. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp)
Clinical Messaging #2:
Secure Patient/Physician e-mail (Provider and Patient or Family Communication): Trigger or respond to electronic communication (inbound and outbound) between providers and patients or patient representatives with pertinent actions in the care process. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004.
Clinical Reminders (Clinical Guideline Prompts):
The ability to remind clinicians to consider certain actions at a particular point in time, such as prompts to ask the patient appropriate preventive medicine questions, notifications that ordered tests have not produced results when expected, and suggestions for certain therapeutic actions, such as giving a tetanus shot if one has not been given for 10 years. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative Foundation, 2005.
Clinical User Authentication:
The process used by the HIE to determine the identity of the person accessing the system with adequate certainty to maintain security and confidentiality of personal health information and to administer with certainty of identity a regulated process such as e-prescribing and chart signing.
Computerized Provider Order Entry (CPOE): A computer application that allows a physician's orders for diagnostic and treatment services (such as medications, laboratory, and other tests) to be entered electronically instead of being recorded on order sheets or prescription pads. The computer compares the order against standards for dosing, checks for allergies or interactions with other medications, and warns the physician about potential problems. Reference: United States Department of Health and Human Services. Office of the National Coordinator for Health Information Technology (ONC) Glossary: http://www.hhs.gov/healthit/glossary.html.
Confidentiality:
A 3rd party's obligation to protect the personal information with which it has been entrusted.
Controlled Clinical Vocabulary: A system of standardizing the terms used in describing client-centered health and health service-related concepts.
Conversion Services:
Consulting services offered by the vendor. These services will take your original data, either in paper or electronic form, and transfer the data into the EHR system database.
Data Center:
The physical space and hardware used by the HIE to house its operations if these assets are kept within the HIE.
Data Integrity:
The accuracy and completeness of data, to be maintained by appropriate security measures and controls. Preservation of the original quality and accuracy of data, in written or in electronic form.
Data Recovery Services:
A mechanism and process to safely store duplicate databases and recreate the data should a disaster occur.
Decision Support:
Computerized functions that assist users in making decisions in their job functions. In the practice of medicine, these functions include providing electronic access to medical literature, alerting the user to potential adverse drug interactions, and suggesting alternative treatment plans for a certain diagnosis.
Decryption:
The technique of using mathematical procedures to "unscramble" data so that an unintelligible (encrypted) message becomes intelligible.
Demographics: Information about name, address, age, gender, and role used to link patient records from multiple sources in the absence of a unique patient identifier.
DICOM (Digital Imaging Communications in Medicine): A standard which defines protocols for the exchange of medical images and associated information (such as patient identification details and technique information) between instruments, information systems, and health care providers. It establishes a common language that enables medical images produced on one system to be processed and displayed on another.
Digital Signature:
A string of binary digits which is computed using an encryption algorithm. Digital signatures enable signatory authentication, confirmation of data integrity, and non-repudiation of messages.
Doctor Matching:
The process of cross-linking the multiple provider identifiers in a community from a variety of provider identifier sources and creating a master doctor identifier with a key for cross-referencing the various community identifiers.
Document Review, Edit, Sign:
A software process that allows for the secure review, editing, and signature through electronic, distributed technology of electronic health record components, such as operative reports, discharge summaries, and consultations.
eLaboratory:
The electronic delivery of laboratory results to practices so that such data may be integrated into electronic patient records in a full EHR system, or used by a dedicated application to view structured, context-rich, and/or longitudinal laboratory results on a patient. eLaboratory includes closing the orders loop, documenting the review of results by clinicians, and documenting that the results have been communicated to the patient. The full benefits of eLaboratory are not achieved until the results are used as input into clinical decision support systems (CDSS).
Electronic Billing (Claims, Eligibility, Remittance):
The ability to contact the payer before the patient is seen and get a response that indicates whether or not the services to be rendered will be covered by the payer. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative, 2005.
Electronic Billing Support:
The ability to contact the payer before the patient is seen and get a response that indicates whether or not the services to be rendered will be covered by the payer. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based HIE Initiatives and Organizations." Washington: eHealth Initiative Foundation, 2005.
Electronic Health Record: Electronically maintained information about an individual's lifetime health status and health care.
Electronic Imaging Results Delivery:
The ability to accept messages from radiology sources and integrate the data for presentation to a clinician. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations. " Washington: eHealth Initiative Foundation, 2005.
Electronic Prescribing (Pharmacy Communication):
Provides features to enable secure bidirectional communication of information electronically between practitioners and pharmacies or between practitioner and intended recipient of pharmacy orders. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp
Electronic Quality Data Submission (Performance and Accountability Measures): Support the capture and reporting of quality, performance, and accountability measures to which providers/facilities/delivery.
Electronic Referral Management:
The ability to generate and/or receive summaries of relevant clinical information on a patient that are typically transferred between healthcare providers when a patient is referred to a specialist or admitted or discharged from a hospital. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative Foundation, 2005.
Electronic Referrals and Authorizations:
The ability to generate and/or receive summaries of relevant clinical information on a patient that are typically transferred between healthcare providers when a patient is referred to a specialist or admitted or discharged from a hospital. Reference: eHI Foundation. "Second Annual Survey of State, Regional and Community-based HIE Initiatives and Organizations. " Washington: eHealth Initiative Foundation, 2005.
Electronic Signature:
A digital signature, which serves as a unique identifier for an individual. Reference:
Encryption: The process of enciphering or encoding a message so as to render it unintelligible without a key to decrypt (unscramble) the message.
E-Prescribing: Provides features to enable secure bidirectional communication of information electronically between practitioners and pharmacies or between practitioner and intended recipient of pharmacy orders. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp
Health Information Exchange (HIE): The mobilization of healthcare information electronically across organizations within a region or community.
HIE provides the capability to electronically move clinical information between disparate healthcare information systems while maintaining the meaning of the information being exchanged. The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care.
Formal organizations are now emerging to provide both form and function for health information exchange efforts. These organizations (often called Regional Health Information Organizations, or RHIOs) are ordinarily geographically-defined entities which develop and manage a set of contractual conventions and terms, arrange for the means of electronic exchange of information, and develop and maintain HIE standards.
Although HIE initiatives differ in many ways, survey results and eHI experiences with states, regions and communities indicate that those who are experiencing the most success share the following characteristics. They are:
Governed by a diverse and broad set of community stakeholders;
Develop and assure adherence to a common set of principles and standards for the technical and policy aspects of information sharing, addressing the needs of every stakeholder;
Develop and implement a technical infrastructure based on national standards to facilitate interoperability;
Develop and maintain a model for sustainability that aligns the costs with the benefits related to HIE; and
Use metrics to measure performance from the perspective of: patient care, public health, provider value, and economic value.
Reference: eHealth Initiative. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative, 2005.
Health Care Interoperability:
Assures the clear and reliable communication of meaning by providing the correct context and exact meaning of the shared information as approved by designated communities of practice. This adds value by allowing the information to be accurately linked to related information, further developed and applied by computer systems and by care providers for the real-time delivery of optimal patient care.
Health Level Seven (HL7): An ANSI approved American National Standard for electronic data exchange in health care. It enables disparate computer applications to exchange key sets of clinical and administrative information.
ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th Revision): The 1992 revision of the international disease classification system developed by the World Health Organization.
ICD-10-CM (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification): The American modification of the ICD-10 classification system, for field review release in 1998.
ICD-10-PCS (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Procedural Classification System): A classification system for reporting clinical procedures, to accompany ICD-10-CM, developed in the US, for 1998 field review release.
ICD-9 (International Classification of Disease, 9th Revision): The 1972 revision of the international disease classification system developed by the World Health Organization.
ICD-9-CM (International Classification of Disease, 9th Revision, Clinical Modification): The American modification of the ICD-9 classification system for both diagnoses and procedures.
Implementation Services: Consulting services offered by the vendor. These services will provide planning and actual implementation of an EHR system. It is important when comparing quoted implementation costs that physicians understand which detailed cost line items a particular vendor will be supplying. Also, make sure and take a look at their project plans.
Informatics: The application of computer science and information science to the management and processing of data, information, and knowledge.
Interface: Shared boundary between two functional units defined by various characteristics pertaining to the functions, physical interconnections, signal changes, and other characteristics as appropriate.
Interface to ADT System: The interface between an HIE and the systems that are sources for admission, discharge and transfer (ADT) of patients in the care delivery setting and that are resident within care delivery institution.
Interface to ASP EHR System: The interface between an HIE and Electronic Health Records (EHRs) that are maintained on ASP platforms (i.e. NexGen, AllScripts).
Interface to Claims System: The interface between an HIE and the systems that are sources for or routing pathways for claims data that are resident within health plans and claims clearinghouses.
Interface to EKG System: The interface between an HIE and the systems that are sources for EKG results that are resident within dispensing physician offices and hospitals.
Interface to Eligibility System: The interface between an HIE and the source data of which people have eligibility for which type of benefits that are resident within health plans and are not infrequently web-enabled.
Interface to Formulary System: The interface between an HIE and the systems that are sources for formulary status of specific drugs for specific health benefit designs and that are resident within pharmacy benefit management companies and hospitals.
Interface to Laboratory System: The interface between an HIE and systems that are sources of laboratory data.
Interface to Pharmacy System: The interface between an HIE and the systems that are sources for prescription data or that are resident within dispensing pharmacies, pharmacy benefit management companies and hospitals.
Interface to Practice Management System: The interface between an HIE and the systems that are sources for the financial management systems of physician practices.
Interface to Provider List System: The interface between an HIE and the systems that track the multiple providers and their identifying data that are resident within health plans, dispensing pharmacies, pharmacy benefit management companies laboratories, physician practices, and hospitals.
Interface to Provider Office EHR System: The interface between an HIE and EHRs that are maintained in practice-specific systems (e.g. EPIC).
Interface to Radiology System: The interface between an HIE and systems that are sources for radiological data.
Interface to Transcribed Reports System: The interface between an HIE and the systems that are sources for transcribed reports. Typically these systems are based at a transcription service or at a hospital and contain admission and discharge notes and consultations, operative reports, and pathology and radiology results.
Interoperability:
The ability of two or more systems or components to exchange information and to use the information that has been exchanged accurately, securely, and verifiably, when and where needed.
The International Organization for Standardization (ISO): It is a worldwide federation of national standards bodies from some 130 countries, one from each country. ISO's work results in international agreements which are published as International Standards.
Key Certificate: A data record that authenticates the owner of a public key for an asymmetric algorithm. It is issued by a certification authority and is protected by a digital signature allowing the certificate to be verified widely. The certificate may also contain other fields beside the value to the key and the name of the owner, for example an expiration date.
Keys: A sequence of symbols that controls the operations of encryption and decryption.
LOINC (Logical Observation Identifiers, Names, and Codes): The LOINC databases provide sets of universal names and ID codes for identifying laboratory and clinical test results. The purpose is to facilitate the exchange and pooling of results, such as blood hemoglobin, serum potassium, or vital signs, for clinical care, outcomes management, and research.
Medication Matching: The process of cross-linking the multiple possible medication identifiers naming conventions in a community from a variety of systems housing medication information and creating a master medication identifier with a key for cross-referencing the various community identifiers. For example there are hundreds of NDC codes for identical drugs as well as HCPCS codes that identify the same drug as NDC codes.
Medication Reconciliation: Alerts providers in real-time to potential administration errors such as wrong patient, wrong drug, wrong dose, wrong route and wrong time in support of medication administration or pharmacy dispense/supply management and workflow. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp
Message Integrity: Protecting a message against its unauthorized modification, often by the originator of the message generating a digital signature.
Messaging to Pharmacies: The process of communicating electronically with pharmacies. This typically includes the cost of communication lines and processes between the HIE and pharmacies. This is necessary to support the e-prescribing function when that function includes the process of electronically sending a digital prescription to the pharmacy.
Messaging to Providers: The process of communicating electronically with providers. This typically includes the cost of communication lines and processes between the HIE and provider terminals.
National Health Information Network: An interoperable, standards-based network across the nation for the secure exchange of heath care information. Reference: HHS Awards Contracts to Develop Nationwide Health Information Network. 2005.
Network Connectivity: The process used for maintaining connection for communication between the HIE and a data source (laboratory, radiology practice, physician practice, or hospital) and data user (physician practice or hospital).
Network: A set of connected elements. For computers, any collection of computers connected together so that they are able to communicate, permitting the sharing of data or programs.
Order Entry: The process of communicating health care provider orders through electronic, computerized processes.
OSI (Open Systems Interconnection): An international standard for networking adopted by the ISO (International Organization for Standardization). This 7-layer model offers the widest range of capabilities for networking.
Outbreak Surveillance: Support clinical health state monitoring of aggregate patient data for use in identifying health risks from the environment and/or population. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp
Parallel Pathways for Quality Healthcare: eHI has developed a set of principles and framework for alignment of incentives with both quality and efficiency goals as well as HIT capabilities within the physician practice and health information exchange capabilities across markets. This Framework—entitled “Parallel Pathways for Quality Healthcare” offers significant guidance to states, regions and communities who are exploring health information exchange as a foundation to address quality, safety and efficiency challenges.
Participant Roles: Examples of roles that may be recognized by the health system that participate in events affecting the health of people:
Provider
Governor
Manager
Recipient
Researcher
Educator
Worker
Family Member
Roles may be used to authorize an individual's access to information system functionality.
Patient Matching: The process of cross-linking the multiple patient identifiers in a community from a variety of patient identifier sources and creating a master patient identifier with a key for cross-referencing the various community identifiers. This is also referred to as a record locator service.
Pay-for-Performance/Quality Data Reporting: Supports the capture and reporting of quality, performance, and accountability measures to which providers/ facilities/ delivery systems/communities are held accountable including measures related to process, outcomes, and/or costs of care, may be used in 'pay for performance' monitoring and adherence to best practice guidelines. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp
Record (PHR): An electronic application through which individuals can maintain and manage their health information (and that of others for whom they are authorized) in a private, secure, and confidential environment. Reference: United States Department of Health and Human Services. Office of the National Coordinator for Health Information Technology (ONC) Glossary: http://www.hhs.gov/healthit/glossary.html. 2005
Public Key Infrastructure (PKI): A conceptual framework that enables the encryption, decryption and electronic "signing" of data transmissions in a secure fashion within an open network environment.
Privacy: Right of an individual to control the circulation of information about him-/herself within social relationships; freedom from unreasonable interference in an individual's private life; an individual's right to protection of data regarding him/her against misuse or unjustified publication.
Private Key: In asymmetric cryptography, the key which is held only by the user for signing and decrypting messages.
Public Health Outbreak Surveillance: Supports clinical health state monitoring of aggregate patient data for use in identifying health risks from the environment and/or population.
Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp
Public Health Processor: A software product that processes extracted data from health care provider systems for the purpose of tracking, trending, and reporting for public health reasons.
Public Key Certificate: A data record that authenticates the owner of a public key for an asymmetrical key system. It is issued by a CA and is protected by a digital signature, allowing the certificate to be verified widely.
Public Key: In asymmetric cryptography, the key which is published by the user to encrypt messages and so that others may verify his/her signature.
Recommend Treatment and Monitoring: The basis of cost, local formularies or therapeutic guidelines and protocols. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp
Registration Authority: An entity (group or agency) that has been delegated by a CA to perform a specific set of ‘trusted authority’ functions within PKI.
Results Answer Matching: The process of cross-linking the multiple possible answers to asking for a given result. For instance, asking for the results of a chest x-ray could yield a dictated report or a digital image of an x-ray. In any case, the case received must be matched across the type of result to a term identifying a common result.
Results Name Matching: The process of cross-linking the multiple possible names of data results that can contain the same information. For instance a blood glucose reading can be called up by a blood glucose test, an SMA panel, or a glucometer result.
Results Review (Alerts to Providers): The ability to interpret the clinical data that is entered about a patient using a set of rules or algorithms which will generate warnings or alerts at various levels of severity to a clinician. These are intended to make the clinician aware of potentially harmful events, such as drug interactions, patient allergies, and abnormal results that may affect how a patient is treated, with the intention of speeding the clinical decision process while reducing medical errors. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative Foundation, 2005.
Results Review: The ability to interpret the clinical data that is entered about a patient using a set of rules or algorithms which will generate warnings or alerts at various levels of severity to a clinician. These are intended to make the clinician aware of potentially harmful events, such as drug interactions, patient allergies, and abnormal results, which may affect how a patient is treated, with the intention of speeding the clinical decision process while reducing medical errors.
Risk Assessment: An evaluation of the chance of vulnerabilities being exploited based on the effectiveness of existing or proposed safeguards or countermeasures.
Risk: The chance of a vulnerability being exploited.
Rules Engine: A set of rules defined within a software process that converts clinical and administrative data streams into a meaningful representation of clinical quality markers to be used in functions such as pay for performance/quality data reporting.
Security: In information systems, the degree to which data, databases, or other assets are protected from exposure to accidental or malicious disclosure, interruption, unauthorized access, modification, removal or destruction.
Service Level Agreement-Compliance: A documented track record of how well the vendor is meeting it’s customer support commitments.
Service Level Agreement-Customer Responsibilities and Duties: The steps that the customer needs to take in order to ensure that the vendor has all the information they need to resolve an issue.
Service Level Agreement-Hours of Support: Methods that will be used for communicating and resolving issues. Typical methods are email, phone, and online chat. Ask whether remote diagnostics and/or on site visits by support analysts are available.
Service Level Agreement-Methods of Support: Will be used for communicating and resolving issues. Typical methods are email, phone, and online chat. Remote diagnostics can be available and, in some instances, it might be necessary to have a support analyst come on site.
Service Level Agreement-Problem Escalation & Triage: The mechanism that defines how a problem migrates through the support system and the different resources that get involved along the way. If a problem can’t be resolved in a certain amount of time, then it escalates until it is resolved.
Service Level Agreement-Response Times: Different functions of the system might warrant different response times based on severity level. There should be a schedule of response times for different types of problems, and the service level agreement should define this accountability.
Service Level Agreement-Severity/Priority Classification: Different types of problems have different levels of urgency and importance. The severity level of a problem is usually noted when a support ticket is opened up. Resolution guarantees are based on severity levels. For example, CPOE down would be a high severity level while a patient education database not working might be a lower level of severity.
SNOMED International: A nomenclature for use by all health services professionals developed in the US and updated at least semi-annually.
Stages of Health Information Exchange Development:
Stage One:
Recognition of the need for HIE among multiple stakeholders in your state, region, or community
Stage Two:
Getting organized by defining shared vision, goals, & objectives, identifying funding sources, and setting up legal & governance structures
Stage Three:
Transferring vision, goals, & objectives to tactics and business plan, defining needs and requirements and securing funding
Stage Four:
Well under-way with implementation – technical, financial, and legal
Stage Five:
Fully operational health information organization. Transmitting data that is being used by healthcare stakeholders Sustainable business model.
Stage Six:
Demonstration of expansion of organization to encompass a broader coalition of stakeholders than present in the initial operational model
Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative Foundation, 2005.
Standard:
Documented agreements containing technical specifications or other precise criteria to be used consistently as rules, guidelines, or definitions of characteristics to ensure that materials, products, processes, and services are fit for their purpose. A standard* specifies a well defined approach that supports a business process and:
Has been agreed upon by a group of experts
Has been publicly vetted
Provides rules, guidelines, or characteristics
Helps to ensure that materials, products, processes and services are fit for their intended purpose
Available in an accessible format
Subject to ongoing review and revision process
*This differs from the healthcare industry's traditional definition of "standard of care."
Statistical Deviation Detector:
Identifies variances from patient-specific and standard care plans, guidelines, and protocols.
The International Organization for Standardization (ISO): It is a worldwide federation of national standards bodies from some 130 countries, one from each country. ISO's work results in international agreements which are published as International Standards.
Third Party-EHR Specific:
Applications that are essential to the basic infrastructure of the system. They are the building blocks, such as the technical platform upon which the EHR system is built (e.g.,Windows, Linux, or MacIntosh, etc.) Also what kind of database structure controls the system (e.g, SQL, Oracle, etc.). When comparing license costs, note if there are separate general system license costs or if these are rolled into the main cost. Also, ask whether there will be additional costs when the vendor upgrades their software and it becomes necessary to install a new version of the database or operating system. Make sure your infrastructure software will support any features you wish to add later on.
Third Party-General System: Applications that are essential to the basic infrastructure of the system. They are the building blocks such as the technical platform the EHR system is built on such as, Windows, Linux, or MacIntosh, etc. Also what kind of database structure controls the system – SQL, Oracle, etc. When comparing license costs note if there are separate general system license costs or if these are rolled into the main cost. Also, will there be additional costs when the vendor upgrades their software and it is necessary to install a new version of the database or operating system. Make sure your infrastructure software will support any features you wish to add later on.
Training Services:
Consulting services offered by the vendor. They provide hands on training for all aspects of the system.
UMLS (Unified Medical Language System):
A long-term research project developed by the US National Library of Medicine to assist health professionals and researchers to retrieve and integrate clinical vocabularies from a wide variety of information sources. The goal is to link information from scientific literature, patient records, factual databases, knowledge-based expert systems, and directories of institutions and individuals in health and health services.
Vendor Software Licenses: License cost of various modules. Typically, modules will be licensed on a concurrent or named user basis. For example, with a concurrent license, if there are 4 providers and 8 employees, a minimum of 12 concurrent licenses would be needed. However, if the providers were halftime [meaning, they only used the system half time] (and all 4 never used the system at any one time, only 10 licenses would be needed). If using a named user license under the same circumstances, 12 licenses would always be needed – as licenses are not shared among different people. There can be a provision though for “active” and “inactive” providers (which means they could look at information, but not enter it in the system). Under an ASP (monthly rental agreement), software licenses are not being purchased, but rented However, the same issues exist for determining number of ASP licenses as with a license purchase.
X12:
A committee chartered by the American National Standards Institute (ANSI) to develop uniform standards for inter-industry electronic interchange of business transactions—electronic data interchange (EDI).
X12N:
The principle responsibilities of ASC X12N Insurance Subcommittee are development and maintenance of X12 standards, standards interpretations, and guidelines for the insurance industry, including health insurance. Most electronic transactions regarding health insurance claims are conducted using these standards, many of which are mandated by HIPAA.
The website development and some of the content in the Toolkit have been made possible by grant number 1D1BTM00095-01 and 02, through the Health Resources and Services Administration HRSA Office of the Advancement of Telehealth (HRSA/OAT). The contents are solely the responsibility of the authors and do not necessarily represent the official view of HRSA/OAT.
Sunday, June 3, 2007
The Impact of Electrons
After working at developing a RHIO for three years, the complexities of this project impressed upon me the need for a compendium for physicians, providers and health IT personell. Anyone who is a provider, hospital administrator, claims manager and payor already know how complex the process has become to provide quality care and receive rewarding reimbursement.. I use the term “rewarding reimbursement” to differentiate making a profit that allows for capital investment and the ability to offer reasonable salaries and benefits to workers in the healthcare field. No one, physicians, hospitals, nor employees enjoys working 50-60 hour work weeks to be only able to skim along the bottom, or worse lose money.
We often hear or speak about quality assurance and improvement, measured by a variety of means and measures, some of which do not do either, but cost to develop numbers that payors would like to have and will be published on non credible public sites, such as the internet. We all know that statistics and studies can be misleading and misinterpreted, especially since demographics are vastly different for many hospitals and providers. Statistics emanating from UCLA and/or Cedar Sinai cannot be compared with a hospital in rural Blythe, Tehachapi or El Centro. There is now a “profit motive” for those who would publish these “statistics” for consumers to review.
A key concern for me is that much of the information being studied comes not from a clinical record, but from financial claims data. Assumptions based on this data to develop QA or pay for reporting is simply nonsense, as most physicians realize. Somehow or other we are not getting this message to the public, but consumer advocacy groups are moving forward with this concept of “infommercials”.
As I make my “rounds” discussing HIE and RHIOs I find most CEOs and even some CIOs eyes glaze over as I approach this topic. They are busy just “surviving”, trying to go faster and faster and cutting costs to survive. True visionaries that I meet are looking for a “solution” that IT will catalyze, not only in the adoption of IT, but redesigning the work flow of the practice and/or institution. The true power of the EMR and HIE lies in this overall process, not just the flow of electrons.
We often hear or speak about quality assurance and improvement, measured by a variety of means and measures, some of which do not do either, but cost to develop numbers that payors would like to have and will be published on non credible public sites, such as the internet. We all know that statistics and studies can be misleading and misinterpreted, especially since demographics are vastly different for many hospitals and providers. Statistics emanating from UCLA and/or Cedar Sinai cannot be compared with a hospital in rural Blythe, Tehachapi or El Centro. There is now a “profit motive” for those who would publish these “statistics” for consumers to review.
A key concern for me is that much of the information being studied comes not from a clinical record, but from financial claims data. Assumptions based on this data to develop QA or pay for reporting is simply nonsense, as most physicians realize. Somehow or other we are not getting this message to the public, but consumer advocacy groups are moving forward with this concept of “infommercials”.
As I make my “rounds” discussing HIE and RHIOs I find most CEOs and even some CIOs eyes glaze over as I approach this topic. They are busy just “surviving”, trying to go faster and faster and cutting costs to survive. True visionaries that I meet are looking for a “solution” that IT will catalyze, not only in the adoption of IT, but redesigning the work flow of the practice and/or institution. The true power of the EMR and HIE lies in this overall process, not just the flow of electrons.
Thursday, May 10, 2007
Quality Assurance, Standards, Interoperability
By coincidence Steve Beller, PhD in his recent blog on trusted.md 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 http://healthtrain.blogspot.com 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 www.calrhio.org 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".
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 www.calrhio.org 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
Administrator
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
Bonnie Cassidy, MPA, RHIA, FAHIMA, FHIMSS
Director
Cherry, Bekaert & Holland, LLP
Rose Dunn, RHIA, MBA, CPA, CHPS, FACHE
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
Administrator
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
MassPRO
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,
CCD
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
President
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
CMIO
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
Neurologist
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.net (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 3.0.3.5) 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
· Workflow.com, 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
Ref: http://trusted.md/ (RHIO MONITOR) http://healthtrain.blogspot.com/
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
Administrator
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
Bonnie Cassidy, MPA, RHIA, FAHIMA, FHIMSS
Director
Cherry, Bekaert & Holland, LLP
Rose Dunn, RHIA, MBA, CPA, CHPS, FACHE
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
Administrator
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
MassPRO
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,
CCD
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
President
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
CMIO
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
Neurologist
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.net (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 3.0.3.5) 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
· Workflow.com, 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
_uacct = "UA-174969-3";
urchinTracker();
__CMS_PostbackForm.action = '/physicians/overview.htm';
Information compiled 05/08/2007 Gary M. Levin M.D. Regional Coordinator IERHIO
Ref: http://trusted.md/ (RHIO MONITOR) http://healthtrain.blogspot.com/
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
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 (www.hcpro.com)]
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.
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 (www.hcpro.com)]
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.
Friday, April 13, 2007
More on Scott Shreve and HIE from CALRHIO
For those of you who have already read Scott's blog you will realize here is an experienced professional who has laid "the railroad tracks" for Enterprise Health Records. I recommend the article highly to others.
CALRHIO has elaborated a comprehensive plan for the state of California to plan and implement a Health Information Exchange Backbone. This structure will be built out by Medicity and Perot Systems. It will integrate both state, county and private health care providers.
For details I have extracted the information from their posting.
It follows:
HIE Utility Service at-a-Glance
PURPOSE
To build a statewide health information exchange (HIE) utility service that will offer California health care providers and patients secure electronic access to patient medical records, where and when needed.
CalRHIO’s primary goal is to deliver critical health information services securely, reliably, and affordably to clinicians, patients, state, county, and federal health agencies, and communities throughout California.
PROFILE
The CalRHIO HIE Utility Service will provide a suite of services from which individual organizations and regional efforts can select to use some, all, or none. The financing model is designed so that participants are not paying for initial development and implementation of the utility service. Those who benefit pay only for the services they need and use.
The CalRHIO HIE Utility Service will provide health information exchange services that are:
available at a price that no one entity can achieve alone
flexible and adaptable to support a wide variety of legacy systems and technical environments – services adapt to existing technology
designed to permit local users to consume and pay only for those services they find valuable and are not duplicative of services provided locally
ARCHITECTURE
Service Oriented Architecture (SOA): SOA framework and Web services platform facilitates scalable, incremental growth and is capable of quickly deploying new services through the re-use of existing services. Because of the variability in IT system environments, as well as the diversity of business and clinical landscapes within health care communities, no one architectural model will suffice. Given the existing challenges, an architectural style of design for constructing HIE models must be flexible and adaptable to resolve variability and diversity issues. A Web services implementation of SOA can meet these complex, diverse business and technical requirements characteristic of HIE initiatives.
UTILITY SERVICES
Phase I: Establish a state layer or “backbone” of data and services
Phase II: Create regional overlays that leverage and expand on the state layer by adding local data sources and additional services
STATE LAYER - State Network Backbone consists of data and services
· Data: state and multi-regional clinical feeds (claims history from payers, lab/pathology reports from national labs, Meds from RxHub and SureScripts)
· Applications: Master Patient Index (MPI), Record Locator Service (RLS), e-Prescribing
· Options (for regions that are ready):
o Integration Hub: translates patient-centric health information between various Electronic Medical Record (EMR) vendor applications
o EMR Gateway: clinical feeds from lab/path reports from national labs, Meds from RxHub and SureScripts to the physician’s EMR application
REGIONAL LAYER – regional overlay of state network with local data and services
· Data: Local clinical data from hospitals, local labs and imaging facilities (data to include labs, radiology reads, transcription, etc.)
· Application Services: include a MPI; RLS; Electronic Health Record (HER) & Personal Health Record (PHR); medication management (e-Prescribing & medication reconciliation); clinical messaging (referral, lab & imaging orders and results; and data warehouse for reporting and analysis
· Integration Hub Service : translates patient-centric health information between various EMR vendor applications.
· EMR Gateway Service: clinical feeds from lab/path reports from national labs, Meds from RxHub and SureScripts to the physician’s EMR application
State Layer
State of California Clinical Data Services
MPI
RLS
EMR Gateway
Patient
Payor
Provider
Claims
History
RxHub
SureScripts
National
Labs
National Data Feeds
Statewide, Real-time
Clinical Data Access
Region A
State of California Clinical Data Services
MPI
RLS
EMR Gateway
Patient
Payor
Provider
Claims
History
RxHub
SureScripts
National
Labs
National Data Feeds
Region
B
Region
C
Regional Layer
Local Data
(From Labs, Hospitals, EMR)
EMR Gateway
Regional Reporting
BENEFITS FOR ALL USERS
· An information infrastructure that supports optimum care delivery methodologies, transparency, patient empowerment, and integrated health care records
· A utility-like infrastructure that moves health care information efficiently and at a cost that is a small fraction of the money saved for payers, patients, and providers alike
· Affordable utility services that facilitate regional health information exchanges and interconnections among them
PHASE I USERS
· EMERGENCY DEPARTMENTS
· CLINICS
· PHYSICIAN OFFICES
PRIVACY and SECURITY
Users must be authorized and authenticated and have either obtained a patient’s consent or documented an emergency. All data sharing will be carried out pursuant to state and federal laws involving patient consent, privacy, and security. Will require all appropriate parties agree on data sharing scope and methodology.
PARTICIPATION
Participation by individual organizations and communities is completely voluntary. Participation is NOT mandated by any private or public entity.
FAQ
Q: Why is CalRHIO creating a technology platform of its own instead of relying entirely on local organizations to provide a technology platform that satisfies local needs?
A: Time is of the essence. On average, every business day in California more than 50,000 patients are receiving suboptimal clinical care solely because we do not have a comprehensive method for moving patient records where and when they are needed. To rely solely on local organizations to individually engage in the expensive and time consuming effort to select vendors, develop detailed requirements, and supervise a complex HIT project will materially delay the widespread sharing of important patient medical information. CalRHIO is offering an option that organizations and communities can use to meet their individual needs and help advance HIE throughout the state.
CalRHIO and ITS STRATEGIC PARTNERS
Medicity and Perot Systems Corporation were selected to build the CalRHIO utility service through a competitive bidding process. Medicity and Perot Systems were selected because their solution offers a strong, proven, and scalable technology platform that will eliminate limitations on how individual health care organizations and local communities design and implement the health information exchange services they need.
In addition to a suite of solutions that are already integrated and interoperable, Medicity and Perot Systems brought an innovative financial model to the table that will enable CalRHIO to sustain the project long term. Creating a sustainable business model is one of the biggest challenges for health information exchange efforts nationally.
COST AND FINANCING
· The financing model eliminates the front-loaded expenses that penalize the early adopters.
· Cost to the Point of Sustainability: Capital required to finance an implementation that is thereafter sustainable without further capital infusion will require up to $300M with financing coming in two stages: 1) initial private equity funding covering the phase one build of the state HIE backbone and 2) after backbone delivery of basic information and proof of concept, final funding with more traditional debt financing replacing private equity capital. A connected California could save $9B annually.
Stakeholder
HIE Benefits
Physicians
· More “real time” information from outside clinical setting
· Rapid access to test results and ability to track medication history
· Changes the point of clinical aggregation from physician’s desk to having aggregated clinical data accessible electronically – reportable and available anywhere, anytime
· Improves referred patient flow, eligibility determination
· Improve patient experience
· Improves administrative efficiencies and offers administrative savings
· Improves the consistency and completeness of documentation
Health Plans
· Potential to drive down administrative costs
· No capital required; only an expense-related payment, and then only after patient HIE services actually rendered
· Potential to significantly reduce expenditures for unnecessary, redundant, or ineffective services
· Pathway to improved care, quality
· Support for value driven health care and pay-for-performance by helping health care organizations track and document the efficiency and appropriateness of care patients received
· Potential to perform widespread data capture for analysis of utilization rates and quality and performance measurements, which has the potential to reduce costs and improve quality of care
Hospitals
· Reductions in administrative times: (Experience of Indiana HIE is 12 min. reduction in nurse and pharmacist time for each admission as a result of “delivering synthesized useful medication histories to hospitals”)
· Improves care delivery and efficiency through immediate access to information that assists clinicians in diagnosis and treatment
· Support for medication reconciliation in accordance with JCAHO requirements
· Source for patient coverage eligibility for both private and public health plans/insurance
Patients
· Improve care at the point of delivery (including reduced medical errors)
· Improve overall coordination of care
· Improve application of evidence-based medicine
· Facilitate greater patient engagement in their health care through networked personal health records
Employer
· Improve transparency on cost and quality
· Help educate consumers about value and ultimately reduce cost through increased preventive care and lower hospital admissions
· Improve quality of care and reduce preventable admissions
Public Health
· Move toward ability to aggregate surveillance data of disease and critical patient information during disasters or bioterrorist threats
CALRHIO has elaborated a comprehensive plan for the state of California to plan and implement a Health Information Exchange Backbone. This structure will be built out by Medicity and Perot Systems. It will integrate both state, county and private health care providers.
For details I have extracted the information from their posting.
It follows:
HIE Utility Service at-a-Glance
PURPOSE
To build a statewide health information exchange (HIE) utility service that will offer California health care providers and patients secure electronic access to patient medical records, where and when needed.
CalRHIO’s primary goal is to deliver critical health information services securely, reliably, and affordably to clinicians, patients, state, county, and federal health agencies, and communities throughout California.
PROFILE
The CalRHIO HIE Utility Service will provide a suite of services from which individual organizations and regional efforts can select to use some, all, or none. The financing model is designed so that participants are not paying for initial development and implementation of the utility service. Those who benefit pay only for the services they need and use.
The CalRHIO HIE Utility Service will provide health information exchange services that are:
available at a price that no one entity can achieve alone
flexible and adaptable to support a wide variety of legacy systems and technical environments – services adapt to existing technology
designed to permit local users to consume and pay only for those services they find valuable and are not duplicative of services provided locally
ARCHITECTURE
Service Oriented Architecture (SOA): SOA framework and Web services platform facilitates scalable, incremental growth and is capable of quickly deploying new services through the re-use of existing services. Because of the variability in IT system environments, as well as the diversity of business and clinical landscapes within health care communities, no one architectural model will suffice. Given the existing challenges, an architectural style of design for constructing HIE models must be flexible and adaptable to resolve variability and diversity issues. A Web services implementation of SOA can meet these complex, diverse business and technical requirements characteristic of HIE initiatives.
UTILITY SERVICES
Phase I: Establish a state layer or “backbone” of data and services
Phase II: Create regional overlays that leverage and expand on the state layer by adding local data sources and additional services
STATE LAYER - State Network Backbone consists of data and services
· Data: state and multi-regional clinical feeds (claims history from payers, lab/pathology reports from national labs, Meds from RxHub and SureScripts)
· Applications: Master Patient Index (MPI), Record Locator Service (RLS), e-Prescribing
· Options (for regions that are ready):
o Integration Hub: translates patient-centric health information between various Electronic Medical Record (EMR) vendor applications
o EMR Gateway: clinical feeds from lab/path reports from national labs, Meds from RxHub and SureScripts to the physician’s EMR application
REGIONAL LAYER – regional overlay of state network with local data and services
· Data: Local clinical data from hospitals, local labs and imaging facilities (data to include labs, radiology reads, transcription, etc.)
· Application Services: include a MPI; RLS; Electronic Health Record (HER) & Personal Health Record (PHR); medication management (e-Prescribing & medication reconciliation); clinical messaging (referral, lab & imaging orders and results; and data warehouse for reporting and analysis
· Integration Hub Service : translates patient-centric health information between various EMR vendor applications.
· EMR Gateway Service: clinical feeds from lab/path reports from national labs, Meds from RxHub and SureScripts to the physician’s EMR application
State Layer
State of California Clinical Data Services
MPI
RLS
EMR Gateway
Patient
Payor
Provider
Claims
History
RxHub
SureScripts
National
Labs
National Data Feeds
Statewide, Real-time
Clinical Data Access
Region A
State of California Clinical Data Services
MPI
RLS
EMR Gateway
Patient
Payor
Provider
Claims
History
RxHub
SureScripts
National
Labs
National Data Feeds
Region
B
Region
C
Regional Layer
Local Data
(From Labs, Hospitals, EMR)
EMR Gateway
Regional Reporting
BENEFITS FOR ALL USERS
· An information infrastructure that supports optimum care delivery methodologies, transparency, patient empowerment, and integrated health care records
· A utility-like infrastructure that moves health care information efficiently and at a cost that is a small fraction of the money saved for payers, patients, and providers alike
· Affordable utility services that facilitate regional health information exchanges and interconnections among them
PHASE I USERS
· EMERGENCY DEPARTMENTS
· CLINICS
· PHYSICIAN OFFICES
PRIVACY and SECURITY
Users must be authorized and authenticated and have either obtained a patient’s consent or documented an emergency. All data sharing will be carried out pursuant to state and federal laws involving patient consent, privacy, and security. Will require all appropriate parties agree on data sharing scope and methodology.
PARTICIPATION
Participation by individual organizations and communities is completely voluntary. Participation is NOT mandated by any private or public entity.
FAQ
Q: Why is CalRHIO creating a technology platform of its own instead of relying entirely on local organizations to provide a technology platform that satisfies local needs?
A: Time is of the essence. On average, every business day in California more than 50,000 patients are receiving suboptimal clinical care solely because we do not have a comprehensive method for moving patient records where and when they are needed. To rely solely on local organizations to individually engage in the expensive and time consuming effort to select vendors, develop detailed requirements, and supervise a complex HIT project will materially delay the widespread sharing of important patient medical information. CalRHIO is offering an option that organizations and communities can use to meet their individual needs and help advance HIE throughout the state.
CalRHIO and ITS STRATEGIC PARTNERS
Medicity and Perot Systems Corporation were selected to build the CalRHIO utility service through a competitive bidding process. Medicity and Perot Systems were selected because their solution offers a strong, proven, and scalable technology platform that will eliminate limitations on how individual health care organizations and local communities design and implement the health information exchange services they need.
In addition to a suite of solutions that are already integrated and interoperable, Medicity and Perot Systems brought an innovative financial model to the table that will enable CalRHIO to sustain the project long term. Creating a sustainable business model is one of the biggest challenges for health information exchange efforts nationally.
COST AND FINANCING
· The financing model eliminates the front-loaded expenses that penalize the early adopters.
· Cost to the Point of Sustainability: Capital required to finance an implementation that is thereafter sustainable without further capital infusion will require up to $300M with financing coming in two stages: 1) initial private equity funding covering the phase one build of the state HIE backbone and 2) after backbone delivery of basic information and proof of concept, final funding with more traditional debt financing replacing private equity capital. A connected California could save $9B annually.
Stakeholder
HIE Benefits
Physicians
· More “real time” information from outside clinical setting
· Rapid access to test results and ability to track medication history
· Changes the point of clinical aggregation from physician’s desk to having aggregated clinical data accessible electronically – reportable and available anywhere, anytime
· Improves referred patient flow, eligibility determination
· Improve patient experience
· Improves administrative efficiencies and offers administrative savings
· Improves the consistency and completeness of documentation
Health Plans
· Potential to drive down administrative costs
· No capital required; only an expense-related payment, and then only after patient HIE services actually rendered
· Potential to significantly reduce expenditures for unnecessary, redundant, or ineffective services
· Pathway to improved care, quality
· Support for value driven health care and pay-for-performance by helping health care organizations track and document the efficiency and appropriateness of care patients received
· Potential to perform widespread data capture for analysis of utilization rates and quality and performance measurements, which has the potential to reduce costs and improve quality of care
Hospitals
· Reductions in administrative times: (Experience of Indiana HIE is 12 min. reduction in nurse and pharmacist time for each admission as a result of “delivering synthesized useful medication histories to hospitals”)
· Improves care delivery and efficiency through immediate access to information that assists clinicians in diagnosis and treatment
· Support for medication reconciliation in accordance with JCAHO requirements
· Source for patient coverage eligibility for both private and public health plans/insurance
Patients
· Improve care at the point of delivery (including reduced medical errors)
· Improve overall coordination of care
· Improve application of evidence-based medicine
· Facilitate greater patient engagement in their health care through networked personal health records
Employer
· Improve transparency on cost and quality
· Help educate consumers about value and ultimately reduce cost through increased preventive care and lower hospital admissions
· Improve quality of care and reduce preventable admissions
Public Health
· Move toward ability to aggregate surveillance data of disease and critical patient information during disasters or bioterrorist threats
Monday, April 2, 2007
Sunday, March 25, 2007
NATIONAL HEALTH INFORMATION NEWS-WATCH
Timely and current information regarding RHIOs in the United States is available at NHIN Watch, http://nhinwatch.com/performSearch.cms?channelId=1
The Office of the National Coordinator for Health Information Technology (ONCHIT) offers a listserv mail list which announces what ONCHIT is doing to advance RHIO development.
It can be found at: https://list.nih.gov/archives/health-it.html
The Office of the National Coordinator for Health Information Technology (ONCHIT) offers a listserv mail list which announces what ONCHIT is doing to advance RHIO development.
It can be found at: https://list.nih.gov/archives/health-it.html
Sunday, March 18, 2007
Google announces collaboration with Practice Fusion
Practice Fusion and Google, the internet search engine have announced a collaboration whereby the EMR and RHIO solution will be offered to providers free of charge. Income will be derived from advertising banners supplied and linked by Google, which will be accessible from the EMR pages used by the provider online. Privacy issues are one of the main concerns for this business model, which however can be addressed since the advertising would not be linked to particular patient's records.
Featured in RHIO Monitor CALRHIO selects Vendors
Featured in: RHIO MonitorCalRHIO Selects Medicity and Perot Systems Corporation to Build Statewide Health Information Exchange for California
CalRHIO Selects Medicity and Perot Systems Corporation to BuildStatewide Health Information Exchange for California
SAN FRANCISCO, Calif., March13, 2007 – CalRHIO announced today that it has selected Medicity, Inc.,teamed with Perot Systems Corporation (NYSE:PER), to build a statewidehealth information exchange utility service that will offer Californiahealth care providers secure electronic access to patient medicalrecords, where and when they are needed.
“CalRHIO’s primary goal is to deliver critical health informationservices reliably and affordably to clinicians, patients, state,county, and federal health agencies, and local exchange effortsthroughout California,” said CalRHIO CEO and President DonaldHolmquest, MD, JD. “Medicity and Perot Systems were selected becausetheir solution offers a strong, proven, and scalable technologyplatform that will eliminate limitations on how individual health careorganizations and local communities design and implement the healthinformation exchange services they need.”
“In addition to a suite of solutions that are already integrated andinteroperable, Medicity and Perot Systems brought an innovativefinancial model to the table that will enable us to sustain the projectlong term,” said Molly Coye, MD, MPH, one of the founding directors ofCalRHIO’s board and CEO and president of the Health Technology Center.“Creating a sustainable business model is one of the biggest challengesfor health information exchange efforts nationally,” Coye noted, citingfindings of a federal study she chaired last year that assessed ninestatewide HIE initiatives.
Medicity and Perot Systems’ first step will be to assist in theprocurement of private seed money to fund start-up costs for theCalRHIO HIE utility service, including building the statewide backboneinfrastructure and integration, marketing and communication, andCalRHIO’s operating budget. Financing requirements for this phase areestimated at $300 million.
The health information exchange platform will make it possible forphysician offices, hospitals, and health plans that have invested inhealth information technology to use their current technology to accessdata outside their walls. While details of charges are yet to bedetermined, the savings expected as a result of having betterinformation will be many times greater than the cost, according toHolmquest.
Through its partnership with Medicity and Perot Systems, CalRHIOwill offer a suite of secure, privacy-protected services from whichorganizations can select to use all, some, or none. For example, forcommunities that want to enable all their health care providers toexchange information, CalRHIO’s HIE utility service will offer anoptional alternative to building and financing their owninfrastructure. For communities that have already initiated localhealth information exchange efforts, the services offered will becompatible and complementary.
“It is imperative that we get a technology solution up and runningas soon as possible to accommodate the needs of California doctors,hospitals, and patients,” Holmquest said. “Every day in California,50,000 or more patients are experiencing suboptimal care solely becauseimportant medical information is missing from their records. Payers andpatients are paying huge additional costs because of the fragmentedcare that result from lack of timely information.”
-
CalRHIO Selects Medicity and Perot Systems Corporation to BuildStatewide Health Information Exchange for California
SAN FRANCISCO, Calif., March13, 2007 – CalRHIO announced today that it has selected Medicity, Inc.,teamed with Perot Systems Corporation (NYSE:PER), to build a statewidehealth information exchange utility service that will offer Californiahealth care providers secure electronic access to patient medicalrecords, where and when they are needed.
“CalRHIO’s primary goal is to deliver critical health informationservices reliably and affordably to clinicians, patients, state,county, and federal health agencies, and local exchange effortsthroughout California,” said CalRHIO CEO and President DonaldHolmquest, MD, JD. “Medicity and Perot Systems were selected becausetheir solution offers a strong, proven, and scalable technologyplatform that will eliminate limitations on how individual health careorganizations and local communities design and implement the healthinformation exchange services they need.”
“In addition to a suite of solutions that are already integrated andinteroperable, Medicity and Perot Systems brought an innovativefinancial model to the table that will enable us to sustain the projectlong term,” said Molly Coye, MD, MPH, one of the founding directors ofCalRHIO’s board and CEO and president of the Health Technology Center.“Creating a sustainable business model is one of the biggest challengesfor health information exchange efforts nationally,” Coye noted, citingfindings of a federal study she chaired last year that assessed ninestatewide HIE initiatives.
Medicity and Perot Systems’ first step will be to assist in theprocurement of private seed money to fund start-up costs for theCalRHIO HIE utility service, including building the statewide backboneinfrastructure and integration, marketing and communication, andCalRHIO’s operating budget. Financing requirements for this phase areestimated at $300 million.
The health information exchange platform will make it possible forphysician offices, hospitals, and health plans that have invested inhealth information technology to use their current technology to accessdata outside their walls. While details of charges are yet to bedetermined, the savings expected as a result of having betterinformation will be many times greater than the cost, according toHolmquest.
Through its partnership with Medicity and Perot Systems, CalRHIOwill offer a suite of secure, privacy-protected services from whichorganizations can select to use all, some, or none. For example, forcommunities that want to enable all their health care providers toexchange information, CalRHIO’s HIE utility service will offer anoptional alternative to building and financing their owninfrastructure. For communities that have already initiated localhealth information exchange efforts, the services offered will becompatible and complementary.
“It is imperative that we get a technology solution up and runningas soon as possible to accommodate the needs of California doctors,hospitals, and patients,” Holmquest said. “Every day in California,50,000 or more patients are experiencing suboptimal care solely becauseimportant medical information is missing from their records. Payers andpatients are paying huge additional costs because of the fragmentedcare that result from lack of timely information.”
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Tuesday, March 6, 2007
Cerner Statement
I missed last week’s deadline for RHIO MONITOR and Health Train Express due to some interviews and other related projects on EMR. I myself am in the midst of examining and implementing an EMR for my practice. In the process I have had the advantage of my research and study of RHIO as coordinator of a RHIO. In my evaluation it has become apparent that having an EMR which is certified by CCHIT is the ticket of admission, for any serious vendor. All that hard work of the past two years is paying off and demonstrates the process will take time and much patience. Of course I am speaking to the choir, but it emphasizes that we need to do a lot more educating of our fellow physicians. The scope and depth of understanding varies tremendously amongst physicians about EMRs, and RHIOs. There continues to be a divide between vendors and providers. According to my sources they have a difficult time and spend much of it explaining IT to providers. Providers’ eyes glaze over when given a new set of vocabulary and how these systems operate. The differences are also generational. Younger MDs have a set of material from their education which now exposes almost all school children to the basics and more of computers. Microsoft Windows is now the W of the three Rs.
One publication I have access to is a resource is “Functional Matrix” of a number of EMR solutions as prepared by the American Academy of Ophthalmology. While focused on ophthalmology it organizes in a readable manner the items all provider should look at when examining EMRs.
This resource can be found at: http://www.aao.org/aaoesite/promo/business/EMR3.cfm
A profound statement by the CEO of Cerner was quoted in iHealthbeat, published by the California Health Foundation.
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Cerner CEO: Revamp Health Care Reimbursement SystemMarch 01, 2007
The U.S. health care reimbursement system is "grossly inefficient" and "needs to be changed," Cerner Chair and CEO Neal Patterson said Tuesday at the Healthcare Information and Management Systems Society conference in New Orleans, the Kansas City Star reports.Patterson cited the Healthe Mid-America program, run by Cerner, as an example of how the system could be improved. The independent, not-for-profit program manages the employee health records of Cerner and about 20 other Kansas City-area businesses. Program participants can use an electronic debit and information card to pay for a physician visit and to access computerized personal health records with a PIN, the Star reports. Patterson cited a study that found that 31% of U.S. health care spending is on administrative costs and said that one of Cerner's "goals is to eliminate insurance companies as they exist today." The Healthe Mid-America program is being tested in the Kansas City area, and Cerner hopes eventually to expand the program nationwide, the Star reports (Karash, Kansas City Star, 2/28).
End quote: The Kansas City Star link expands on this brief .
One publication I have access to is a resource is “Functional Matrix” of a number of EMR solutions as prepared by the American Academy of Ophthalmology. While focused on ophthalmology it organizes in a readable manner the items all provider should look at when examining EMRs.
This resource can be found at: http://www.aao.org/aaoesite/promo/business/EMR3.cfm
A profound statement by the CEO of Cerner was quoted in iHealthbeat, published by the California Health Foundation.
“
Cerner CEO: Revamp Health Care Reimbursement SystemMarch 01, 2007
The U.S. health care reimbursement system is "grossly inefficient" and "needs to be changed," Cerner Chair and CEO Neal Patterson said Tuesday at the Healthcare Information and Management Systems Society conference in New Orleans, the Kansas City Star reports.Patterson cited the Healthe Mid-America program, run by Cerner, as an example of how the system could be improved. The independent, not-for-profit program manages the employee health records of Cerner and about 20 other Kansas City-area businesses. Program participants can use an electronic debit and information card to pay for a physician visit and to access computerized personal health records with a PIN, the Star reports. Patterson cited a study that found that 31% of U.S. health care spending is on administrative costs and said that one of Cerner's "goals is to eliminate insurance companies as they exist today." The Healthe Mid-America program is being tested in the Kansas City area, and Cerner hopes eventually to expand the program nationwide, the Star reports (Karash, Kansas City Star, 2/28).
End quote: The Kansas City Star link expands on this brief .
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