By Joseph Conn / HITS staff writer

On balance, it would appear that members of the open-source healthcare software community are satisfied with the proposed changes in the way electronic health records systems will be tested and certified by the federally supported Certification Commission for Healthcare Information Technology.

Earlier this month, CCHIT announced it was adding two new testing and certification regimes to meet what CCHIT Chairman Mark Leavitt called an anticipated “stampede” toward EHR adoption, triggered by an estimated $34 billion in Medicare and Medicaid subsidy payments under the American Recovery and Reinvestment Act of 2009. In both new schemes, CCHIT said it would test and certify that EHR systems effectively meet the “meaningful use” standards now under development by HHS instead of just CCHIT’s own long list of discrete EHR functions used exclusively in the three previous rounds of CCHIT testing up to this point.

The stimulus law requires providers to not only use “certified” EHR systems, but also to use them in a “meaningful manner.” The CMS, which will oversee the official rulemaking process for HHS in determining “meaningful use,” is expected to have an initial set of standards ready for publication early next year.

The changes to the certification process also seem to align with requests made of CCHIT by open-source advocates to make its testing and certification process more amenable to the peculiarities of open source development, according to four open-source mavens contacted for this story.

“It was surprising to us,” said Fred Trotter, a programmer, blogger and co-founder of the Liberty Medical Software Foundation, Houston, a recently formed not-for-profit organization seeking to promote what Trotter describes as free and open-source software (FOSS) in the U.S. healthcare IT market. “I’m happy and everybody in the community is happy, too.”

And in a recent e-mail to community members, Trotter said, “I am personally endorsing the new CCHIT certification programs for certification for ARRA funding.”

That happy state of affairs reflects a sea change for Trotter, who as recently as March, in an e-mail to open-source community members, wrote: “The largest single threat to the future of FOSS in healthcare in the U.S. is the certification process mandated by the stimulus act,” adding that “CCHIT has had an anti-open source stance for years.”

Open-source advocates indicated their focus would be on the two new testing regimes directly linked to the meaningful-use criteria. Trotter and others said the new programs will afford the open-source community, as well as vendors of proprietary software and end users, more flexibility. They also expressed satisfaction that CCHIT had addressed open-source issues as quickly as it has.

One prominent wellspring of open-source clinical IT system software is the Veterans Affairs Department. Copies of the VA’s Veterans Health Information Systems and Technology Architecture, or VistA software system, often called FOIA VistA because of its availability under the Freedom of Information Act, are available to the public without charge.

Technically, the VistA system is referred to as public domain software, although the bulk of the VistA code was developed by programmers operating within the VA in a fashion that was similar to the development model of open-source used to produce the popular Linux operating system and Apache Web server software, according to VistA cognoscenti.

A VistA cousin, the Resource and Patient Management System, or RPMS, developed by the Indian Health Service, also available under FOIA, is starting to find some traction outside the IHS with public health clinics.

Physician Edmund Billings is the chief medical officer and executive vice president of Medsphere Systems, Carlsbad, Calif., the developer of OpenVistA, a commercial version of the VistA clinical IT system used by the Veterans Affairs healthcare system. Medsphere also owns the intellectual property rights to the VueCentric graphical user interface of RPMS. Medsphere is “in the process” of seeking certification for its version of VistA and RPMS, he said.

Billings also said he sees the changes at CCHIT as positive developments, but was holding back on a full endorsement. “I’m pleasantly surprised,” he said. “I think the way CCHIT handled this was graceful and thoughtful and responsive to the industry. It hit me that they were listening. It opened the door. We are happy with the modular option.” Still, he said, “I think the devil will be in the details.”

Although Medsphere’s VistA derivative is not yet CCHIT-certified, according to Billings, “The go forward for Medsphere is to be a certified EHR technology as to the stimulus bill. Our clients are going to want to get paid for meaningful use and part of our service is to get them certified for meaningful use.”

In addition, Billings said it makes sense, from the government’s point of view, to have a certification system linked to what the government is paying for, i.e., meaningful use.

Mike Ginsburg is marketing manager for Document Storage Systems, Juno, Fla., developer of vxVistA, also a commercial VistA derivative. DSS received CCHIT certification for vxVistA in 2007. Ginsburg, too, said, “Generally, we were happy that CCHIT was paying attention to the open-source community,” but added that he, too, will withhold final judgment until the details of the program are made known.

“We’ll see what the specifics are,” he said. “Whatever we have to do to allow our customers to be eligible for ARRA money, that’s what we’ll do.”

Joseph Dal Molin is a Toronto-based IT consultant on the board of directors of WorldVistA, a not-for-profit organization that developed WorldVistA EHR VOE, an open-source variant of the VA’s system that also received CCHIT certification in 2007.

Dal Molin is currently working in Amman, Jordan, as a consultant with Electronic Health Solutions, a not-for-profit corporation set up by the Jordanian health system, which is installing WorldVistA at a government-run hospital and outpatient clinic. Perot Systems was hired as the lead integrator on the pilot project.

Cost, not complexity, was the biggest problem the WorldVistA community had with CCHIT under its initial testing and certification model, Dal Molin said.

WorldVistA’s EHR was CCHIT-certified in April 2007 to the then-current 2006 criteria, a certification that’s good through April 2010. It cost the organization $38,000 for initial testing and around $4,800 per year to continue to use the CCHIT seal in WorldVistA advertising, Dal Molin said. That adds up to nearly $50,000 for the three-year life of the certification, a lot of money for a small, not-for-profit organization, Dal Molin said.

“Having gone through the comprehensive model, I think it’s doable,” Dal Molin said. “For the open-source community, all they need to do is drop the costs, because you really are gambling. We felt we would be investing all of WorldVista’s savings and not being assured of getting anything back.”

On the one hand, that comprehensive model might seem stringent, but on the other hand, Dal Molin argued against dumbing down the proposed new meaningful-use certification criteria too much.

“We’re thankful that CCHIT is listening to making certification more accessible to others and so on, but ultimately, certification has to serve clinical improvement, not giving people and easy pass to going after ARRA money. That would be, ultimately, a mistake,” he said.

While open-source software has captured only a tiny fraction of the healthcare IT market thus far, there is plenty of room for growth.

Meanwhile, Congress, HHS, and a handful of commercial vendors and consultants are raising the open-source profile. This week, HHS is hosting a two-day conference in Washington, D.C., on its CONNECT project, an open-source software interface the government developed to link federal healthcare IT systems to the proposed National Health Information Network.

Above article published on http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090629/REG/306299994/1153&AssignSessionID=373357728181706

Bernie Monegain, Editor

CHICAGO – The American Medical Association has adopted new guiding principles for physicians in the event a patient’s electronic medical record is breached. AMA members approved the guidelines at the group’s annual policy-making meeting earlier this week in Chicago.

“Protecting the privacy and safety of patient information, whether in a paper record or an electronic medical record, is a top priority for physicians,” said AMA board member William A. Dolan, MD. “Physicians need a standard protocol to follow to maintain patient security in the event of a breach of personal information.”

Medical information housed in an EMR travels from patient to healthcare provider to health insurance industry with limited regulation and oversight, Dolan noted. Security breaches can happen and physicians need guidance about their responsibilities if health information has been compromised.

The new AMA guidelines ask physicians to:

• Ensure patients are properly informed of the breach,
• Follow ethically appropriate procedures for disclosure,
• Support responses to security breaches that place the interests of patients above those of physician, medical practice or institution, and
• To the extent possible, provide information to patients to enable them to diminish potential adverse consequences of the breach of personal health information.

“EMRs are the wave of the future, so it is important for both patients and physicians to feel secure” Dolan said. “These new guidelines prepare physicians to help patients in the unfortunate situation of an information breach.”

Above article published on

http://www.healthcareitnews.com/news/ama-weighs-emr-security-breaches

WPI team launches international study to glean insights and best practices for realizing the benefits of electronic medical records and health care IT systems

WORCESTER, Mass. – The push is on to bring the U. S. health care system into the digital age by replacing paper-based systems now used at many medical facilities with electronic medical records systems and other information technology (IT) tools. To understand how best to realize the benefits these systems can provide, a team of experts at Worcester Polytechnic Institute (WPI) has launched a three-year study of health information technology (HIT) systems now in various stages of implementation at four medical organizations—two in the United States and one each in Canada and Israel.

Funded by a $750,000 grant from the National Science Foundation, the study will focus on the primary care setting to examine and analyze how implementing HIT systems impacts medical providers, their patients, and the operations of the health care delivery system. The goal of the study is to develop new insights and best practices to help guide future HIT implementations at other medical facilities. “Adapting to computer systems will be a learning process for primary care organizations, for physicians, and even for patients,” said Diane Strong, Ph.D., professor of management at WPI. “From what we observe, we will develop new ideas and new concepts for health care delivery, such as better ways of organizing work flow and decision making to take advantage of the new opportunities enabled by these IT systems.”

Strong and colleagues Sharon Johnson, Ph.D., associate professor of industrial engineering, and Isa Bar-On, Ph.D., professor of mechanical engineering, are the principal investigators leading the study. The team has extensive experience analyzing the impact of IT systems in other large organizations, such as global manufacturing companies, which have been using enterprise-wide computer systems for decades, with varying degrees of success. “As we’ve seen in many other complex organizations, just installing an IT system alone typically doesn’t achieve efficiencies,” Johnson said. “What has to happen is that an organization and its processes need to adapt to realize the efficiencies and quality improvements that are enabled by IT—and that’s tough to do. If processes don’t adapt, then just imposing at IT system alone can be counter-productive.”

In the United States, the study will focus on two organizations in Massachusetts: Fallon Clinic, a large group medical practice located throughout Central Massachusetts, and UMass Memorial Heath Care, an integrated medical system with 700 primary care physicians, several community hospitals, and an academic medical center serving Central New England. In Canada, which has universal coverage and a single-payer funding system, the study will include primary care offices of the Vancouver Coastal Health District. In Israel, which has a hybrid health care delivery model with four health funds that provide medical care to the entire population, the study will examine primary care practices in two of the health funds.

These four sites were chosen because of their diversity of operating models, management structures, financial systems and cultural differences. The sites are all at different points on the continuum of migrating from paper-based systems to fully digital systems, giving the researchers a broader range of perspectives and data for analysis. Israel, for example, has the most extensive experience with HIT, with more than 90-percent of physicians there already using the technology. “Looking at the experience in Israel will give us a reality check,” Professor Bar-On said. “We’ll see what works, and what doesn’t, and learn from people who have been using these systems for more than 10 years. And we will examine how the organization changes in response to the implementation of these systems. We want to see how people live with the systems.”

Over the course of the three-year study, the research team, working closely with the leadership at each of the primary care sites, will conduct an extended series of interviews and observational sessions with physicians, management and support staff. The researchers will observe the planning for HIT implementations and the roll-out of the systems in various locations, and examine how management and staff adapt to the new systems and tools.

“We are fortunate to have outstanding partners at the four clinical sites to work with on this project,” Professor Strong said. “We are not evaluating any particular software package or software vendor. Our focus is on how organizations must adapt to realize the potentially transformative benefits that can be achieved by the use of these new systems and the data they will collect.”

About Worcester Polytechnic Institute

Founded in 1865 in Worcester, Mass., WPI was one of the nation’s first engineering and technology universities. WPI’s 14 academic departments offer more than 50 undergraduate and graduate degree programs in science, engineering, technology, management, the social sciences, and the humanities and arts, leading to bachelor’s, master’s and PhD degrees. WPI’s world-class faculty work with students in a number of cutting-edge research areas, leading to breakthroughs and innovations in such fields as biotechnology, fuel cells, information security, materials processing, and nanotechnology. Students also have the opportunity to make a difference to communities and organizations around the world through the university’s innovative Global Perspective Program. There are more than 20 WPI project centers throughout North America and Central America, Africa, Australia, Asia, and Europe.

Above article published on http://www.eurekalert.org/pub_releases/2009-03/wpi-mti030509.php

Director, Business Development
Software Advice

Should you implement an EMR or an EHR? Do you know the difference? Is there a difference? These are only a few, but very important questions that IT implementers at a healthcare organization face while deciding which software to select from all the variety offered in the market.

In theory, and by definition, there is a difference and it should play into any provider’s clinical software selection. At the same time, marketing messages and technical terminology have clouded healthcare providers’ understanding of the two software definitions.
Recently, the National Alliance for Health Information Technology (NAHIT), established definitions for electronic medical records (EMR), electronic health records (EHR), and personal health records (PHR). NAHIT is a senior leadership organization dedicated to leveraging the power of health IT to improve the US healthcare system.

EMR and EHR as NAHIT defines it

The NAHIT has produced the following definitions for EMR and EHR:

EMR: The electronic record of health-related information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in the individual’s health and care.

EHR: The aggregate electronic record of health-related information on an individual that is created and gathered cumulatively across more than one health care organization and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care.

By these definitions, an EHR is an EMR with interoperability (i.e. integration to other providers’ systems).

Who needs which?

Marc Anderson, CEO of the AC Group, says it comes down to the words ‘medical’ and ‘health.’ An EHR will provide a more comprehensive view into a patient’s health and history by pulling information from other systems, providing clinical decision support and alerting providers to health maintenance requirements. It will help providers report and measure quality indicators for pay-for-performance incentives.

Meanwhile, an EMR is the record of a single diagnosis or treatment maintained in silos, most likely used by a specialist. If your responsibility is to take care of one unique problem - such as an orthopedist setting a bone - then a stand-alone EMR may well be sufficient. Certain specialists may not need information about patient history as much as they need specialty-specific workflows and templates.

The market is still figuring it out

Despite the NAHIT definitions, we think the market is still figuring out which definitions to adopt. An analysis of Google Trends data shows that roughly four times more searches are performed for ‘electronic medical record’ than for ‘electronic health record.’ At the same time, ‘electronic health record’ seems to be gaining in search frequency.

One interesting exception to the data was that the searches originating in Washington, D.C. are split evenly between ‘electronic medical record’ and ‘electronic health record!’

Software vendor marketing migrates slowly

The same is true when we look at the usage of terminology by software vendors.

Why such limited adoption of EHR amongst vendors? First, it simply takes time and effort to change over marketing terms. Moreover, from a very practical standpoint, many vendors will want to continue to use the EMR label while it is the most commonly used - and ‘Googled’ - term for clinical records systems.

Marketing aside…

Regardless of who is using which terms, the key decision process for selecting an EMR/EHR is to map out your organisation’s requirements and methodically assess systems against those criteria.

Justin Barnes, Chairman of the HIMSS Electronic Health Record Association and VP of Marketing and Government Affairs at Greenway Medical Technologies, believes ‘the future of healthcare IT is interoperability.’

And while Barnes is an advocate of the EHR terminology, he distills the following three criteria for selecting a medical records system:

• Current-year interoperability certification standards (CCHIT, HL7); A unique workflow that matches your practice and specialty.
• Excellent usability at the point of care.

If you purchase an EMR or EHR with these three requirements, you should receive a significant ROI on your investment, and position yourself to receive incentives from payers.

Well what’s a PHR?

NAHIT has provided the following definition of a PHR:

ePHR: An electronic, cumulative record of health-related information on an individual, drawn from multiple sources, that is created, gathered, and managed by the individual. The integrity of the data in the ePHR and control of access to that data is the responsibility of the individual.

A PHR should include cumulative health information ranging from past and current illnesses, demographics, allergies, prescriptions and more

To be most effective, a PHR should include cumulative health information ranging from past and current illnesses, demographics, allergies, prescriptions and more. Given the nature of the PHR, it’s the individual’s responsibility to decide what information is stored, and who has access to it.

Even with complete definitions in place, it can be difficult to evaluate EMRs/EHRs and determine which system to buy. At the same time, most providers will make their decisions based on their IT budget and their career stage. A young physician will almost certainly want to lay the IT foundation for participating in the future vision for healthcare interoperability. They will likely be supported in this effort by their health system. Meanwhile, a more mature physician that wants to ‘go paperless,’ but is not an aggressive adopter of IT may well opt for a stand-alone EMR system and forgo the costs and challenges of integration.

In the end, these individual decisions underlie what is a deliberate, but very slow adoption of healthcare technologies.

Above article published on www.ehealthonline.org

SCHAUMBURG., The Certification Commission for Healthcare Information Technology (CCHIT)), the federally recognized body for testing and certifying electronic health records (EHRs), has announced it will develop dermatology-specific functionality criteria beginning in 2009. The CCHIT’s decision was in part a response to an application from the American Academy of Dermatology with support from the American Society for Dermatologic Surgery, American Telemedicine Association, the Medical Dermatology Society, and the Society for Investigative Dermatology as well as overwhelming support from the dermatology community and other key stakeholders.

“Beginning in 2006, CCHIT has placed a ’seal of approval’ on physician office-based EHR products to indicate that the system has met rigorous functionality, interoperability and security criteria for primary care, child health, and cardiology. The American Academy of Dermatology is pleased that the unique needs of dermatologists — who use digital images and body mapping to track patient health — will be recognized,” said dermatologist C. William Hanke, MD, MPH, FAAD, president of the American Academy of Dermatology. “This will be a service to the health care community as it continues to transition to a system that relies on electronic health records and the smooth and secure interchange of data. Dermatologists are committed to helping create functional criteria and technical elements that also will help many different physician specialties.”

CCHIT will appoint a work group of volunteer providers, payers, health IT vendors and other stakeholders to define those functions that will best help dermatologists enhance patient care quality and safety, improve practice efficiency, participate in clinical research and maintain board certification. In addition to spurring EHR adoption by dermatologists, developing dermatology-specific certification criteria has the potential to facilitate EHR care coordination between and among dermatologists and non-dermatologist physicians in various practice settings. CCHIT is expected to launch the dermatology-specific EHR certification program in 2010.

EHR systems refer to individual patients’ medical records in a digital format. These systems aid with accessing clinical information that can enhance patient care by helping to prevent medical errors, improve quality and facilitate clinical research. EHRs have grown in popularity amongst all physicians including dermatologists. However, barriers such as affordability, reliability, and whether the product will communicate with other electronic systems have kept many physicians from fully embracing these systems.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential representative of all dermatologic associations. A sister organization to the Academy, the American Academy of Dermatology Association is the resource for government affairs, health policy and practice information for dermatologists, and plays a role in formulating socioeconomic policies that can enhance the quality of dermatologic care. With a membership of more than 15,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.

Many dermatology practices, are using OmniMD EMR to increase the efficiencies and reduce their costs