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

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

To help transform health care, the state should invest more in electronic infrastructure that supports the automated exchange of electronic medical information, writes Russell Sarbora of Community Health Network of Washington. Increased efficiencies, lower costs and less waste of resources will help improve the health-care system.

By Russell Sarbora Special to The Times

IN Washington, state spending on health care ranks second only to education. The state has consistently asked how we can improve efficiency, reduce costs and focus scarce resources on insuring and caring for more Washingtonians.

The rapid exchange of accurate and timely information is going to transform the delivery of medical care. Infrastructure that supports the automated exchange of electronic medical information is and will continue to be a primary driver for efficient health-care delivery. We need to encourage and realize an efficient infrastructure for interoperability between electronic medical-record systems.

Washington state has at least two key assets already in place that have the potential to support creation of this infrastructure. These are the Washington State Health Care Authority-sponsored Health Information Infrastructure Advisory Board (HIIAB), and the Community Health Network of Washington (CHNW), the nation’s largest system of community health centers.

The 19 community health centers that make up the network are the primary health-care home for more than 600,000 low-income people in Washington state, including one-third of the state’s uninsured adults and one-half of the state’s uninsured children.

At CHNW we are working with HIIAB to achieve its objectives and have already implemented electronic medical-record systems that cover more than 70 percent of our member clinics and more than 85 percent of our patient population.

Business pressures will eventually produce efficient health-data-exchange services for patients served by commercial insurers and providers who rely primarily on commercially insured patients. But who will ensure that similar services are provided to vulnerable populations?

Through continued support for the HIIAB and by strengthening efforts to encourage the interoperability of electronic medical records, Washington state can improve patient health and safety while simultaneously controlling state-funded health-care costs.

Electronic medical records are used in the vast majority of acute-care facilities in Washington state; by all laboratory-service organizations operating in the state; by almost 25 percent of Washington’s primary-care physicians, and by more than 70 percent of CHNW’s member physicians. Yet, there is no statewide or national infrastructure today that supports sharing this information.

This infrastructure needs to be created, and the states that do so will lead the nation in delivery of efficient health care during the next decade. Washington state can and should be a leader in realizing this goal.

To achieve this leadership position, our state must adopt existing data-exchange policies and standards for health-information exchanges between organizations receiving state funding, provide incentives for technology investments required to support health-information exchanges, and financially support pilot programs that enable health-information exchanges.

CHNW is already working with HIIAB to create a Health Record Banking system that supports sharing of health information between patients and their health-care providers. We need to upgrade this existing business process to use current generation technology and thereby overcome existing shortcomings in reliability, efficiency and accuracy.

Interoperability between electronic medical-record systems is the key to achieving widespread sharing of clinical data. Today, these proprietary systems are incented to constrict access to the data they contain and there are numerous unresolved issues regarding access to the data and under what conditions data are shared.

Fortunately, the HIIAB is well-versed in these issues and well-positioned to support their resolution. The HIIAB is already proceeding with the creation of mechanisms to support patient access and control of their health data. However, the single greatest shortfall in the proposed Health Record Bank system is the absence of mechanisms to automatically include physician-created health data in these patient-controlled record systems. Lacking this critical body of data, the value of Health Record Banks will be substantially diminished.

We need to extend the HIIAB charter and role to encourage interoperability between electronic medical-record systems employed in Washington State and to achieve automated exchange of clinical data. The technology to do so already exists. Policy and will are the only hurdles to be overcome.

Russell Sarbora is the chief information officer for Community Health Network of Washington.

Copyright © 2009 The Seattle Times Company

Above article published on http://seattletimes.nwsource.com

Starting on Thursday, residents of Hawaii will be able to pay a flat fee for a 10-minute online visit with a doctor. (Credit: American Well)

For people in Hawaii, going to see the doctor just got as easy as booting up their PC.

The state is the first to offer online physician visits statewide, under a program that kicks off Thursday. Residents can chat with a doctor over a standard Web browser (IE 7 or Firefox 2) or carry out their visit over the telephone. Those with a Webcam can also use that to share video with the doctor. The service will be available 24 hours a day, seven days a week (with a few monthly maintenance outages during low-volume times).

Members of Hawaii’s largest insurer, HSMA (which operates the state’s Blue Cross and Blue Shield) pay $10 for the 10-minute consultation, while non-members pay $45.

The launch comes as the modernization of health care is taking center stage. A Senate working group is scheduled to hold hearings Thursday on the topic, with Microsoft Vice President Peter Neupert among those offering testimony.

Hawaii passed a law in 2006 that paved the way for Thursday’s launch. The legislation led HMSA to look for ways to implement online health care, a search that eventually led the company to Boston-based American Well. The two companies have been working together since last June, along with Microsoft, whose HealthVault system is supported to allow patients to maintain their own health care records.

Proponents of the system caution that while it may help reduce the number of people going to emergency rooms for routine off-hours ailments, it isn’t a substitute in true emergencies.

Doctors in the system are told to apply the same standards of care and address only the kinds of things that can be handled over the phone or Web. Doctors are allowed to issue prescriptions for most medications, but in some cases will not be able to offer a definitive diagnosis within the 10-minute visit.

Family practice doctor Michelle Shimizu, who has been among the doctors helping test the system, said she sees opportunities for handling things like glucose monitoring, discussing lab results as well as for unplanned queries.

“That doesn’t necessarily need to be done on a face-to-face basis.” Shimizu said. At the same time, she doesn’t see traditional visits going away.

“I don’t think this situation can completely replace one-on-one doctor’s visits,” she said. “It’s an adjunct to that.”

She’s found another use for the system. Shimizu, who is in the process of moving her practice from Oahu to the Big Island, said the online option will allow some of her current patients to keep seeing her without having to hop on a plane.

In general, doctors receive $25 for each online visit they handle. They can use the Web to schedule unused time as it becomes available. Doctors, like patients, need only a phone or a PC to participate.

“The $25 has been received tremendously,” said HMSA marketing Vice President Michael Stollar. “They think the fee is very fair,” he said, noting that many offer phone or e-mail follow-up today without getting paid at all.

For now, the company expects doctors to mainly use the service to fill their spare time, though he said that he can imagine a day where a new medical school graduate might choose to set up an online-only practice.

Roy Schoenberg, the CEO of American Well, said that making better use of physicians’ downtime fills a critical need. “There are not enough primary care physicians,” he said. “It really allows us to capture ‘care opportunities’ out of the same number of physicians that were out there.”

form CNET Health news.