Technology Alert: Summer 2005
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A quarterly publication of the California Medical Association • Issue 3 • Spring '06 |
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Assessing the Standards
for Electronic Health Records
Using Technology to Support Physicians and Protect Patients
Physicians make critical decisions every day to protect and restore the health of their patients. The health care field is responding to the call for integrated health communication among providers and patients with the expanding use of electronic health records (EHRs).
This growing health care technology field has hundreds of vendors in the EHR market presenting a bewildering array of options. Many “vetters” are assessing and critiquing the vendors, but determining which of these provide unbiased and reliable information is a daunting challenge. Answers to the questions of how EHR systems should function, how a physician can be certain a vendor’s product can do the tasks that will be required of it, and where to look for additional guidance are critical now more than ever.
How Should an EHR Function?
In the past there were no formal, accepted standards for electronic medical records (EMRs), and today more than 300 vendors offer EMR products. Recently, attention has shifted from EMRs to electronic health records (EHRs). EHRs have emerged as the preferred electronic tool for sharing health information at the point of care. Unlike basic EMRs, which allow doctors to create electronic medical records for their own internal use, more robust and “interoperable” EHRs allow clinicians to exchange medical information with patients and other clinicians electronically.
The Institute of Medicine (IOM) established the baseline for EHRs in the early 1990s. IOM updated this baseline in 2003, stipulating that to be considered functional, an EHR must be feasible to implement and must substantially:
- Improve patient safety
- Support the delivery of effective patient care
- Facilitate management of chronic conditions
- Improve efficiency
In 2004, a voluntary organization, the Certification Commission for Health Information Technology (CCHIT), was formed. By 2005, CCHIT had developed standards built upon the IOM criteria and received and published public comment on these standards. CCHIT’s initial standards focus on functionality, interoperability, security, and reliability.
These two organizations are working with the U.S. Department of Health and Human Services (HHS) and have shown considerable leadership in moving forward the standardization of systems. CMA recommends that the CCHIT-identified criteria be the minimal set physicians should require for any EHRs under consideration.
Certifying EHRs
A bona fide national certification system is necessary to reduce the risks associated with system selection and speedy adoption of EHRs. CCHIT in the fall of 2005 was awarded an HHS contract to certify EHR systems, and the vendor testing phase pilot is now complete. CCHIT is expected to announce the first certified systems for ambulatory care by the summer of 2006.
CCHIT is employing scenarios to test product performance. These scenarios include a well child visit, an OB visit, and a geriatric visit. Designed to test the capability of the EHR to support the physician in improving patient care, these scenarios require demonstration of many elements, including: preventive health care and management of chronic disease; treatment and reporting of communicable diseases; lab orders and results tracking; e-prescribing tools and their ability to highlight potential adverse drug events by warning of drug/drug interactions and patient drug allergies; and the transfer of information between systems in the physician office and with systems of other providers. Physicians who are looking to select a system soon should look at the scenario most relevant to their practice to get an idea of what good systems should be able to do. (Click here for more information.)
CCHIT certification will be on a pass/fail basis, and only products that pass will be announced. Only a few products are expected to pass and be awarded certification. Additionally, certification standards will continue to tighten through 2008 as data standards permit testing of interoperability—a critical component for systems in the future. EHR vendors will have to resubmit their products for testing each year through 2008 to be compliant with these evolving standards. In 2006 CCHIT plans to develop additional criteria for certifying products to address the specific needs of medical specialties. Physicians providing primary medical services and care for chronically ill patients are advised to give strong preference to CCHIT-certified systems.
Because it is likely that many physicians will want to make purchasing decisions prior to the full maturity of the certification process, the Physicians’ Foundations tasked CMA staff and a consulting team to explore sources of vendor review that may be useful in the interim and for selecting among certified systems in the future.
Looking for Guidance in EHR Selection
CMA’s recent health IT survey confirmed that more California physicians are using health IT and many more intend to do so. Twenty-three percent of physicians responding currently have an EMR, with larger practices showing greater likelihood of having made the investment.
Those using EMRs report satisfaction with the products available, with nearly two-thirds of physicians being happy with the EMR they selected. Those who are unhappy, however, are very unhappy—some went so far as to uninstall the product.
Survey respondents cited vendors and other physicians as top sources of product information. Given the anticipated shakeout of EHR products and the lack of market penetration of any given EMR, physicians anticipating purchase are encouraged to check additional sources.
Reliable Sources of EHR Information
The Physicians’ Foundations’ consulting team recently completed a study to identify sources of reliable EHR information. The study reviewed more than 40 sources, finding multiple variations in scope and approach and that many reviews were simply outdated.
The study also found that standards defining attributes in vendor systems continue to fluctuate and vendor participation in reviews is both limited and voluntary. The consulting team noted in its summary several areas of concern about current review processes, including a high reliance on self-reporting information with limited external validation; the lack of comprehensive review; and the fact that some reviewers appeared to be marketing systems rather than serving as unbiased sources of information.
The study identified three potential EHR information sources that came closest to meeting criteria for thoroughness and value of the system reviews. Two of the sources currently available to physicians are the Health Information Management and Systems Society (HIMSS) EHR Selector and the AC Group. A third resource, KLAS, has expanded its collection of customer satisfaction information to also collect and report on vendor financial status and experience with consultants. (CMA partnered with KLAS in 2005 to provide members with customer satisfaction data on health information technology. KLAS ratings are based on user surveys. For more information, visit CMA’s Health IT Resource Center)
The report found that while these sources were useful, none were comprehensive. The summary concluded, “There are significant omissions related to vendor financial stability, adequacy of implementation support, and training procedures and costs.
Being a Cautious Consumer
CMA recommends thoughtful consideration of the system vendors. The EHR systems that will support physicians in the future cannot be determined simply by looking at the myriad functions and features most vendors currently display. More important are the resources of the system to track patient data longitudinally, to provide clinical decision support, and to evolve into the ability to exchange computer-interpretable information with other health care providers as data standards solidify.
Physicians are encouraged to become familiar with the work of CCHIT and be on the lookout for CCHIT-certified systems later this year. For practices that do not wish to wait, to assist in selecting among certified systems, and to aid specialties (such as psychiatry) whose needs are different from general medicine use of unbiased, external resources can provide valuable. The three vetters reviewed by the founcations have websites that physicians are encouraged to review:
Physicians who feel compelled to make a product purchase prior to certification standardization may want to consider tying their contract for the product to CCHIT certification by a specific date.
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Contact: Nileen Verbeten, 916/444-5532 or nverbeten@cmanet.org.
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