Transcript T-2 HIT for LTC 101 - American Health Care Association

HIT for LTC 101
A story of growth…
1
HIT for LTC 101
Tuesday October 9, 2007
Session T-2
Presented by:
Eileen Doll and Nathan Lake
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Introduction
Growth and
expansion…and
seeds
 Experiences
EHR AND
INFORMATION
EXCHANGE
Trunk-IT
components and
knowledge
 Needs
 Ever growing
 To goals…
HIT trunk
Roots
Seeds of need
IT tree
HIT tree
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Seeds of need
National Presidential Healthcare IT Goal

“Within ten years, every American must have a personal electronic
medical record”
George W. Bush, “President Unveils Tech Initiatives for Energy, Health
Care, Internet”, Minneapolis, MN, April 26, 2004

“Executive Order 13335: Incentives for the
Use of Health Information Technology and
Establishing the Position of the National
Health Information Technology
Coordinator” (a) The National Coordinator shall, to the extent
permitted by law, develop, maintain, and direct the implementation of
a strategic plan to guide the nationwide implementation of
interoperable health information technology in both the public and
private health care sectors that will reduce medical errors, improve
quality, and produce greater value for health care expenditures.
Executive Order, George W. Bush, April 27, 2004
4
Seeds of need
National Presidential Healthcare IT Goal

Executive Order 13410--Promoting Quality and
Efficient Health Care in Federal Government
Administered or Sponsored Health Care Programs
“…in order to promote federally led efforts to implement more transparent
and high-quality health care, it is hereby ordered as follows:
…Purpose:…to ensure that health care programs administered or sponsored
by the Federal Government promote quality and efficient delivery of health
care through the use of health information technology, transparency
regarding health care quality and price, and better incentives for program
beneficiaries, enrollees, and providers. …to make relevant information
available to these beneficiaries, enrollees, and providers in a readily useable
manner and in collaboration with similar initiatives in the private sector and
non-Federal public sector. Consistent with the purpose of improving the
quality and efficiency of health care, the actions and steps taken by Federal
Government agencies should not incur additional costs for the Federal
Government.
George W. Bush August 22, 2006
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Needs…
Timetables/plans for other national goals

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2003—HIPAA
2006 and 2007—CCHIT certification for ambulatory EHR
March 2008—CDC convene experts to discuss availability of
local/regional cancer, immunization, trauma or other public health data
base (registry) information
June 2008– CDC facilitate development of national administrative or
legal approaches to allow the routine and emergency inter-state data
exchange of countermeasure and immunization information .
October 2008—CDC to communicate the availability of these “registries”
to assist local/regional public health agencies in emergency efforts
December 2008—laboratories must be able to receive and route
(exchange) all lab results
March 2009—CDC to provide free software to local/regional public
health agencies to manage “outbreaks”
2010—Institute of Medicine--E-prescribing implementation deadline
2014—”EHR for all” implementation
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Needs…THE GOAL—1

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

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Presidential efforts, beginning in 2004, and
Congressional efforts, and
Consumer efforts, and
Healthcare Professional efforts, and
Governmental public health and emergency
management efforts, and
Private, insurance, and governmental payer
efforts to
Electronically
Produce, store and
Confidentially exchange healthcare information
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Needs…THE GOAL—2
 To
provide “better” care—to more people, who
will live longer, and who will require and
REQUEST increasingly more complicated care in
multiple and varied care settings.
 “Better” care includes a reduction of
redundancies, errors, and improper billing—
benefits to the patient, provider and payer.
These efficiencies yield financial benefits
for all=“better value”
 Financial benefits will allow us to CONTINUE to
provide “better care”

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In the next 2 hours we will discuss…

IT—(Information Technology)
 Beginning
seeds of need—how we got
started…
 Development and growth of roots into the
“trunk” or body of IT—a review and definition
of technology components—hardware,
software, and STANDARDS–necessary to
make a computer or system do its intended
job.
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AND…

Health Information Technology—a new tree
develops…with many external forces

Shoots and branches—Terminology, acronyms,
“buzz words”
Roots develop Trunk—HIT STANDARDS—types,
purpose, development, approval, certification
 Branching into—network information exchange—
RHINNHIN

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AND…
 HOW—to
be effectively involved in
your facility or on other levels
 HOW—to decide what HIT solution is
best for YOU
When you come to the fork in
the road…take it…
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And Be SMART©…
TO SUCCEED, the fork must lead to…
 STANDARDS based programs (software), and
 MULTIPLE ways (hardware) to enter information and
to connect;
 ACCEPTANCE by users;
 RELIABLILITY, with
 TECHNOLOGY updates or support when needed
SMART © EDHC INC
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Tree—IT

“Information
technology (IT), as defined by
the Information Technology
Association of America (ITAA) is:
"the study, design, development,
implementation, support or
management of computer-based
Trunk-a body
information systems, particularly
of IT
software applications and computer
knowledge
hardware." In short, IT deals with
the use of electronic computers and
computer software to convert, store,
protect, process, transmit and
retrieve information.”
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Seeds…
 Seeds or
weeds??
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Roots…
 Punch technology—
used since the 1800’s
 Binary—1 0
Each punch represented
DATA, a term first
used in 1946
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Roots …
 IBM card—pink=1st
card of a set
 IBM—normal card
 One of the first IT
 8 bits = 1 byte
“STANDARD” s
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Roots…
Informationpunchesread
data
sortanalyze (computations)
information
Photo used for educational purposes
from IBM photo archives
IBM 7030 “Stretch” computer
Fastest computing 1961 to
1964

Scanned from the Annuals of the History
of Computing, Vol. 3 #4 October 1981
UNIVAC--UNIVersal
Automatic Computer
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Roots and growth……
 Personal…
 Space
 Convenience
 Life is
complicated…
 Can’t quite
stretch for a
“Stretch”…
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Roots trunk
 SO…
Personal Computing was born…
 MITS Altair 8080—
 The Victor 9000 PC
the first PC—
Personal Computer
From pchistory.org
From www.old-computers.org
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Trunk…
 A PC, or any computer, is HARDWARE
Something we can see, feel…or pound on if necessary…
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Trunk…



What HARDWARE
makes a MODERN PC?
A “tower” which encases
standardized key
components and attaches
to other components.
A “hard drive”—which
stores data and software
In fashionable
grey or black
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Trunk…ALL STANDARDIZED
The MOTHERBOARD—this runs the show; all connections
are routed in/onto/out via “slots” or “ports” to integrate
and operate smoothly
Photo Courtesy of Creative
commons
http://creativecommons.org/licenses/by-sa/2.5/
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Trunk …standardized
A peripheral is a device such as:
 A monitor (to display information), a
 Keyboard (or many other types of
device such as an ATM with touch
screen) to enter or input information;
 A modem (to transmit and receive
external information either over phone
line, DSL line, cable or satellite line),
 An accessory drive, either for CD,
DVD, or “floppy”;
 A “mouse” or other device to make
screen selections;
 A printer or other “output” device,
such as speakers…
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Trunk…all standardized…

HARDWARE—

Items such as a Blackberry or other
Assistant; or




Personal Digital
the DSL, T1, phone line, or fiberoptic wire to
PHYSICALLY “connect” a computer to other computers
or to the internet;
A transmitter for “wireless” radio communication;
Any/all of the PHYSICAL interconnections and devices.
Each piece can ONLY DO TASKS FOR WHICH THEY
WERE MECHANICALLY DESIGNED IN A STANDARD WAY
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Trunk…NETWORK

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
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
Small network—for a
small business or small
facility—
“Thin client” terminal or
PC workstations connect
via wire or “wirelessly”
to
Central or “main”
computer—stores all
information and acts as
the “server”
Peripherals are shared
Number of users limited
by number of terminals
From expertsolutionsinc.com
MDS
Business office Activities
Admin
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Trunk…NETWORK
Centralized
data storage
Large multi-purpose
networks…
Data in multiple
areas, can be
shared—example
of RHIO structure
Data in ALL areas—
can be connected to
through a
combination of
routings—examples
are internet, NHIN
 “Communicate”
 Bi-directional
data exchange
In a standard way

From expertsolutionsinc.com
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Trunk…Disc Operating System
 One disc told the system what to do (SOFTWARE)
 One disc stored what was done
“Floppy” disc
EvolutiongrowthSMALLER=MORE STORAGE
 8 inch=10KB, 100,000
characters—about the
size of a 38 page text
document
 5 ¼ inch—
100KB to
1.2 MB
 3 ½--
1.4 MB
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Trunk
 Uppercase AND lower
Video
Interface
Chip
case letters!!
 Software supplied on
disk, cassette and
cartridge!
 Color
 Memory—25KB, 20 KB
ROM, 5 KB RAM
 1980—cost=$300
 =2007 ~ $900
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Trunk…MEMORY

ROM=READ ONLY MEMORY


Used to store data which is infrequently changed, like
how the system should “boot up” or start—this data
REMAINS on the computer hard drive
RAM= RANDOM ACCESS MEMORY
Used to find, use, and store many pieces of data as a
software program “works” or processes data—the data is
not saved when the computer is turned off
 VIRTUAL MEMORY—if memory needs exceed RAM
capabilities, the actual computer hard drive is used for
random data storage

 RAM—more RAM=faster processing within the
limits of the central processing unit—or “chip”
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Trunk--SOFTWARE

SOFTWARE—a “language” which tells the
hardware HOW TO RUN, WHAT TO DO WITH
data and HOW TO STORE data
“System” software—the Operating System
—MS DOS, Windows 98, Windows Vista,
Mac OS, LINUX, UNIX. The OS also contains
software programs or “drivers” which tell
peripherals how to do their tasks…telling a printer
how to actually print.
 “Programming” software—gives the programmer
tools to write our
 “Application” software—which turns keyboard
strokes or items touched on a screen or the button
on a TV remote control into formatted bits/bytes of
data. The data is stored in a specific way so that
INFORMATION can be retrieved or specific actions
taken.

(OS)
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Trunk


Software allows us to make a spreadsheet,
connect to the internet, write and save a letter,
or play Sims® 2 (or 25…).
Software can be “proprietary”, “open source”,
or mixed…
Microsoft Openoffice.org, UNIX,
Word ®


Firefox
Software operates using RAM!!!
More complicated software=More instructions,
more system work and more SPACE to work
in…
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Trunk—needs growing room!
1 bit=1 binary decision
1 or 0—yes or no
8 bits=1 byte
10 bytes=one word
1 stored character
fun
1024 bytes=1 KiloByte
~ The alphabet, plain text, 35
times
1024 KB=1 MegaByte
~2 minute mp3 music file (like from
I-tunes ®); a small novel
1024 MG=1 GigaByte
mp3 music~18 hrs, 1000 novels, a
regular length movie at TV quality
1024 GB=1 TeraByte
50,000 trees  paper, and printed;
est. amount of EHR data produced
by a 250 bed NF in 9 months;
Size of largest PC hard drive
Library of Congress data content as
of 5/2007—”high risk” digital
material
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4 TB
70 TB
Trunk—grow faster…
NO MORE HOT and BULKY
MULTIPLE LARGE TRANSISTORS!!
ADD SPEED
 Central processing unit--
CPU
 One unit—or “chip” which contained multiple small
transistors
 1971—Intel—first PC “chip”—it could only add and
subtract, at 4 bits at a time—but ALL ON ONE CHIP!!!
 The “microprocessor” erupted—silicon fed the “tree”
33
Trunk…rapid speedy growth
 1965, clarified in 1975—Moore’s law—the rate
of the ability to add transistors to chips
doubles approx. every 2 years—a prediction
 1989—80486—1,200,000 transistors
 2004—Pentium 4—125,000,000 transistors
 This growth continues…and bits handled in
larger numbers—from 4 bits, to 8 bits, to 32
bits and now 64 bits.
 Executing one billion instructions
per
second…
34
Branches…need more
Academia, business, and all people wanted to connect
with each other and share their information…
 So…in response…
 Congressman Al Gore
 invented the internet…
 “…a series of tubes.” (Senator Ted Stevens)
NOT!!
35
Trunk
 One large network—with many
small networks and individuals—
communicating via data
exchange…
 Over telephone and later other
“lines”…
MAGIC???
36
Trunk—
exchange data
 TCP/IP—the first, most important
data exchange standard
Transmission Control Protocol and Internet Protocol…
 Developed and tested from 1973
 Adopted by military in 1982
 Adopted in January 1, 1983 as the standard for the internet
 Commercial use began in 1985 (Compuserve, later AOL in
1991)
Without this standard, we would not be here…
37
Trunk—network and internet
communication standard—TCP/IP





Connect—via some type of device—modem (telephone) or ethernet
(cable, DSL)—each connection location has an Internet Protocol
address—in a standardized format and standardized “language”
based on type of connection
Connection is routed to another IP address—standardized format
A data request from one IP address to another is transmitted via a
transmission control protocol (type of data guides which protocol)—
each protocol has standard function and process
The process or application puts data into standardized “packets”
based on the type of data to be transported
This standard will be changing!!!
More users=more addresses needed
Different devices
38
TRUNK—Standards



In the US—standards are developed by
organizations in a field, trade, or industry—a
part of our democratic history
Each organization is comprised of individuals
(“experts in the field”) who know what SHOULD
BE (“best practice” for safety or efficiency) and
the WORST of what actually is.
Standard—represents the expected physical
characteristic or performance—and can change
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Trunk—standards
 Standards CHANGE
 By “vintage” standards,
Marilyn Monroe wore a size
12 dress---
 In “modern” standards, she
would wear a size 6 or 8…
 WHY??
40
Trunk—Standards



an agreed upon “norm”—
“…an approved model…a rule or principle that
is used as a basis for judgment…weight,
measure, value, or comparison…authorized or
approved…” (from Dictionary.com Unabridged
(v 1.1). Random House, Inc.)
STANDARDS for functional or operational
parameters exist for just about everything
A STANDARD IS TESTED and CERTIFIED by
other organizations/agencies
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Trunk…Standards…USA

NIST—“promote U.S. innovation and
industrial competitiveness by
advancing measurement science,
standards, and technology in ways
that enhance economic security and
improve our quality of life.”
From—www.nist.gov
42
Trunk…Standards…USA




ANSI—American National Standards Institute
promotes and facilitates voluntary consensus
standards and ensures their integrity.
provides all interested U.S. parties with a
neutral venue to come together and work
towards common agreements
Standards approved by other organizations
may be submitted to ANSI for “final” approval
and acceptance
From—www.ansi.org
ANSI cooperates internationally
43
Trunk—Standards…international





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ISO—International Organization for Standardization
“…world's largest developer and publisher of International
Standards.
…a network of the national standards institutes of 155
countries, one member per country, with a Central Secretariat in
Geneva, Switzerland, that coordinates the system.
…a non-governmental organization that forms a bridge
between the public and private sectors. On the one hand, many of
its member institutes are part of the governmental structure of their
countries, or are mandated by their government. On the other
hand, other members have their roots uniquely in the private
sector, having been set up by national partnerships of industry
associations.
…enables a consensus to be reached on solutions that meet both
the requirements of business and the broader needs of society.
ISO forms a bridge between the public and private
sectors.”
From—www.iso.org
44
Trunk—IT standards
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Mother and babies.jpg—info
~å¬8’i\•
×¾gñßÄÿ?ˆ7#í±[$ ¹
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݃¢h³ø‡X1@²K  Info in
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—
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à©È ÷?
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£$’JS=þµ
SYMBOL
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 STANDARD DATA
ORDER
DATA
 Info out
45
Trunk—IT Standards…
Data in a file with the “.jpeg” or “.jpg” extension (a
STANDARD developed by the 'Joint Photographic Experts
Group’ a member of ISO) IS ALWAYS STORED USING
THE SAME STANDARD SYMBOL/S AND ALWAYS IN THE
SAME STANDARD ORDER



STANDARDS tell a software program how to convert
entered informationdataPRODUCESTORE/“SAVE”
A FILE ON THE DISK
The STANDARD file “type” is indicated at the end of the
file—the file EXTENSION
STANDARDS tell a software program how to “open” a
data fileconvertdisplay information SAME AS
original, based on the file type
INTEROPERABILITY

INTEGRATED
46
Trunk—IT Interoperability




INTEROPERABLE programs or systems “talk”
to each other—they “communicate” following
exact STANDARDS
Information IN, Information OUT
INTEROPERABLE = COMPATIBLE
INTEGRATED = Built in—act as one
 SOFTWARE—“bells and whistles”, “look”,
“feel”=“USER FRIENDLY”
 If a SOFTWARE program doesn’t produce the
expected STANDARD result, no matter how “userfriendly”, it cannot be used!!
???????????????????????????????????????????????????????????
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Trunk…HIT
H
ealth
 I nformation
 T echnology

“The application of information processing
involving both computer hardware and
software that deals with the storage, retrieval,
sharing, and use of health care information,
data, and knowledge for communication and
decision making.” (D. Brailer, ONCHIT, HHS, 2004)
48
One goal…

From--http://www.flickr.com/photos/juhansonin/393271975/in/set-72057594067707294—a
public file
49
Trunk…EHR



An EHR …
(1) longitudinal collection of Electronic Health
information for and about persons, where health
information is defined as information pertaining to the
health of an individual or health care provided to an
individual; …
And…(4) support of efficient processes for health care
delivery. Critical building blocks of an EHR system are
the electronic health Records (EHR) maintained by
providers (e.g., hospitals, nursing homes, ambulatory
settings) and by individuals (also called personal
health records).”
PHR
IOM report to Agency for Healthcare Research and Quality (AHRQ), July, 2003
50
Trunk…EHR
Healthcare Information and Management Systems Society

“…a longitudinal electronic record of patient health
information generated by one or more encounters in any
care delivery setting. Included in this information are
patient demographics, progress notes, problems,
medications, vital signs, past medical history,
immunizations, laboratory data and radiology
reports. The EHR automates and streamlines the
clinician's workflow. The EHR has the ability to generate a
complete record of a clinical patient encounter - as well as
supporting other care-related activities directly or
indirectly via interface - including evidence-based
decision support, quality management, and
outcomes reporting.”
51
Broken branch??…
EMR=Electronic medical record—refers to
an institution’s or provider’s own record of
medical care for a patient
 May or may NOT meet the standards for
EHR…

52
Trunk…Standards for WHAT???



Content—What information should be included,
eg., lab results, x-ray results, narrative notes,
history, physical findings, care plan
interventions, diagnosis, eye color, name and
nickname, Braden scale?, what pain scale, dog’s
name??
Storage—How the content will be stored as
DATA—nomenclature, ICD9 code, ICD10 code,
standard name, alpha or numeric, mm-dd-yyyy
versus dd-mm-yyyy
Functions—What the system can do—how it
will work—how information can be entered,
stored as data and for how long, retrieved and
presented as information, and communicated
securely when needed
53
Trunk—FUNCTIONALITY Standards
IOM report to Agency for Healthcare Research and Quality (AHRQ), July, 2003
What an EHR should DO--FUNCTIONALITY
54
Trunk—developing HIT standards







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”
(from ehealth initiative at http://toolkit.ehealthinitiative.org/glossary)
55
Standards—the “Bottom line”…
We need standards to allow Information exchange at 3
“interoperability” levels

(From Clinical Loinc tutorial, pg 9, 050321)
 Basic—allows messages to be exchanged between
computer systems—word processing, spreadsheets,
etc.
 Functional—describes the standard syntax (format)
of the message—document templates, forms, data
structures, message standards
 Semantic—requires use of standard vocabularies
within a message
56
Trunk—HIT exchange standards-1



We must be able to exchange different types of
data at different times and in different ways…
1. Clinical messaging--delivers electronic
clinical results (such as laboratory, test results,
radiology reports, or transcribed reports) from
the source system (lab, radiology center, etc.) to
the intended recipients (ordering physician,
primary care physician, hospital, SNF, etc.)
2. Sharing of clinical data at point of care—
gathers and provides electronic clinical
information (history, diagnoses, etc.)
57
Trunk—HIT exchange standards-2

3. Medication history—electronically shares medication
history obtained from multiple sources (pharmacy,
hospital, SNF, MD office) with the clinician or facility
currently treating the patient

4. E-prescribing and/or CPOE (computerized physician
order entry)—automates the process for clinicians to
prescribe medications for patients. “Ideal” systems would
automatically check for drug/drug interaction,
prescription drug plan status, dosage (and other factors)
and provide feedback to clinician
58
Trunk—HIT exchange standards-3

4. Quality metrics—shares healthcare information
among multiple data sources for the purpose of quality
measurement that can support provider quality initiatives
and also serve as the basis for determining incentives
(such as P4P.)
“Metrics”—parameters you or others use
to measure or track periodic assessments of performance
AND the methods to carry out and interpret the
information. A “benchmark” or “best practice” metric may
be company, industry, or patient specific.
Return hospitalizations, fall rate, medication errors,
persons over 60 who received influenza shot, in-house
DU formation, etc. are all possible “metrics”.
59
Trunk—HIT exchange standards-4
 5.
Administrative data sharing—for
emergency and community/public
health purposes—transfer/discharge
from one health setting to another
CCD
HL7 approved standard-Continuity of Care Document —
standardized content, layout,
terminology
Begin testing 2008
60
Trunk—setting standards




Who sets HIT standards, and who makes sure that the standards
produce interoperable data exchange?
SDO—Standards Setting
Organization/s and the individuals in these
organizations…
Within an interwoven structure…
With oversight to be sure standards and products
“harmonize”…
(are interoperable—
work together)
And “certification”
(tested and meeting or exceeding
applicable standards)
for products which do…

With efforts/plan which are “transparent” (visible and open to discussion
and review) to any/all interested parties.
61
Trunk…The plan for growth…


ONCHIT—(AKA ONC)—Office of the National
Coordinator for Health Information Technology
—Robert M. Kolodner, MD—tasks—

1.

2.
consult with HHS Secretary Michael Leavitt–
to implement interoperable EHR by 2014 and
provides management and support for the…
AHIC—American Health Information
Community
62
A public-private “Community” was established to serve as
the focal point for America’s health information concerns
and drive opportunities for increasing interoperability—4
contracts given to carry out specific functions
The Certification
Commission for
Healthcare
Information
Technology
(CCHIT)
Healthcare
Information
Technology
Standards Panel
(HITSP)
American
Health
Information
Community
The Health
Information
Security and
Privacy
Collaboration
(HISPC)

Nationwide
Health
Information
Network
Architecture
Projects (NHIN)
HITSP includes 348 different
member organizations and is
administered by a Board of Directors
24 SDOs (7%)
247 Non-SDOs (71%)
30 Govt. bodies (9%)
12 Consumer groups (3%)
36 Project Team and Undeclared (10%)
The Community is a federallychartered commission and will
provide input and recommendations
to HHS on how to make health
records digital and interoperable, and
assure that the privacy and security
of those records are protected, in a
smooth, market-led way.
Evaluation of Standards Harmonization Process for HIT
63
Trunk branches and grows…
HHS will spend $13M to create AHIC 2.0

WASHINGTON …Office of the National Coordinator (ONC) for
Health IT recently discussed details of its $13 million, 2-year
contract proposal to design a successor for the federal healthcare IT
advisory panel.
Robert Kolodner, MD, the National Coordinator for Health
Information Technology …transitioned to a private-sector successor
by spring of next year.
…part of HHS’s suggested model is for AHIC to derive some of its
own revenue source through charging for access to the Nationwide
Health Information Network.
NHIN
…the standards process currently underway will not be jeopardized,
as the Health Information Technology Standards Panel (HITSP) and
the Certification Commission for Healthcare Information Technology
(CCHIT) will become part of the planning process, Kolodner said.
Reported in Healthcare IT News By Diana Manos, Senior Editor on 09/05/07
64
Trunk—SDO



HITSP
Dr. John Halamka,
Chair
Member populated
Technical Committees
“Health Information
Technology Standards Panel”
The HITSP team–“…a cooperative partnership between the public
and private sectors…Comprised of a wide range of stakeholders…
sponsored by the American National Standards Institute (ANSI) in
cooperation with strategic partners such as the Healthcare
Information and Management Systems Society (HIMSS), the
Advanced Technology Institute (ATI) and Booz Allen Hamilton…”—is
charged with completing eleven different tasks, with current efforts
focused on the harmonization process.
65
Trunk—SDO
Eleven Tasks are included in this contract:
The Community
HHS Secretary
Mike Leavitt, Chair
1.
2.
3.
HHS ONCHIT1
PO, Dr. John Loonsk
HITSP
Dr. John Halamka,
Chair
Member populated
Technical Committees
Project Management Team
Executive in Charge, F. Schrotter, ANSI
Program Manager, L. Jones GSI
Deputy PM, J Corley, ATI
Project Manager, Julie Pooley, BoozAllen
Harmonization
Process Definition
Technical Manager
Michelle Deane, ANSI

Harmonization
Process Delivery
Technical Manager
Joyce Sensmeier,
HIMSS
4.
5.
6.
7.
8.
9.
Comprehensive Work Plan
Conduct a Project Start Up Meeting
Deliver Recommended Use-Cases
Participate in related meetings and
activities, including the AHIC
Meetings
Develop a Gap Analysis
Standards Selection, Evaluations
and Testing
Define a Harmonization Approach
Develop Interoperability
Specifications
Develop and Evaluate a Business
Plan for the self-sustaining
processes
Submit Monthly Reports – ongoing efforts
11. Assist with communications – ongoing efforts
10.
Evaluation of Standards Harmonization Process for HIT
66
Trunk—product certification
Certification Commission for Healthcare Information
Technology
From—www.cchit.org
Will assure that EHR products ARE COMPLIANT with standards as
developed…it…

“…engages multiple stakeholders to ensure an objective, open, and
consensus-driven process and credible result. Stakeholders will
include:

Clinicians and provider organizations who purchase health IT
products;
Safety net providers who purchase or receive health IT products;
Vendors who develop, market, install and support health IT
products;
Payers or purchasers who are prepared to offer incentives for
health IT adoption;
Health care consumers;
Quality organizations;
Public health agencies;
Clinical and health-services researchers;
Standards development organizations;
Federal agencies and coordinating bodies representing various
Federal agencies as identified by the National Coordinator.”









67
Standards—CCHIT & MITRE


“Software to Evaluate Compatibility of Systems Will Be Free and
Publically (SIC) Available
September 10, 2007…Certification Commission for Healthcare Information
Technology (CCHITSM) and the MITRE Corporation…collaborative
relationship… to…evaluate compliance of electronic health records (EHR)
and networks with certification criteria for interoperability... testing
software will be developed under an open source license so that it is free
and publically (SIC) available, and the Certification Commission will use the
software running on a secure platform during its inspection of a product's
compliance…Mark Leavitt, M.D., Ph.D., Commission chair. "It will be a big
job, so we hope many others will collaborate: health IT companies,
government entities and others -- that's why CCHIT and MITRE chose the
open source project model. It's in sync with the Commission's transparent,
volunteer-based processes as well.“ The first focus …tool to verify
standards compliance of a Continuity of Care Document (CCD) sent or
received by EHRs. … project schedule that will have the CCD verification
tool ready in time for CCHIT's 2008 pilot testing and certification
launch.”
From—www.cchit.org
NO MORE SILOS!!
68
WHAT?? SILO? TRANSPARENT??


If each organization maintains its data
in a non-standard way, it is in a
“silo”—
What is a silo??

a Central Park penguin?
 a storage facility for grain?



Silo—the NY Central Park
penguin who raised a
chick with another
male penguin.
No—”Silo”ed means that a system
“stands alone” and is incapable of
reciprocal operation with other related
management systems…
Data exchange requires interoperable
systems…
And how we accomplish this must be
transparent—open to, visible to,
and understandable by all
stakeholders
With transparency,
all becomes clear
69
WHHOOAAAAA!!
Hold on…2008???
I like my silo!!
Paper keeps me warm!!
Where’s my SPACE!!!
I need TIME!!!
This is CRAZY!!! Prep, plan, change…
70
Trunk—SDO—HIPAA
Health Insurance Portability
and
Accountability Act
Personal Health Information
•
Privacy
•
Security of Electronic Records
71
Trunk—SDO
•NIST—special division to test conformance to IT
standards
•Gathers and displays current HIT standards at
http://hcsl.sdct.nist.gov:8080/hcsl/index.html
•May become a bigger “player” in HIT standards
development…
72
Trunk—SDO—CHI
Consolidated Health Informatics
(initiative)
•Under FHA (Federal Health Architecture) Program under ONC (Office of the
National Coordinator)
•“CHI is a collaborative effort to adopt health information interoperability
standards, particularly health vocabulary and messaging standards, for
implementation in federal government systems. About 20
department/agencies including the Department of Health and Human
Services, the Department of Defense and the Department of Veteran's
Affairs are active in the CHI governance process.”
•Established 27 health domains
•Now working on
•“Implementation of adopted standards,
•Maintenance of adopted standards, and
•Identification and adoption of new standards.”
From:
www.hhs.gov/healthit/chi.html
73
Trunk—SDO—function



HL7—Health Language 7—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. (from ehealth initiative)
EHR-S (System) Functional Model—the EHR-S
Functional model standardizes what functions our LTC
EHR must possess—in areas of Direct Care, Information
Infrastructure, and Supportive Services
The standard indicates the functions which may, should,
or SHALL be included, structured, or “work” in an EHR
system
74
Trunk—SDO—function

In February 2007, at this year’s LTC HIT summit, the
Chicago attendees received, and responded to, a
challenge—
 Develop the HL7 LTC EHR-S profile—
participate and reach consensus with your
expert colleagues



4 PERSONS LED AND STILL LEAD THE CHALLENGE…
136 LTC colleagues “answered” the challenge… care
providers, vendors, IT specialists, pharmacy consultants,
nurses, government liaisons, and many others…
But not all “met” the challenge”—for 1 ½, 3, or 5 or
more hours each week—thinking and communicating, to
develop and approve each profile section…
75
Trunk—SDO—function
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected], [email protected];
frank.mckinney@achievehealthca re.com; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; matthew.mullins@momentumhealth ware.com;
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected]; [email protected];
[email protected]; [email protected]; [email protected]; [email protected];
[email protected];
76
Trunk—SDO—function
LTC EHR-S Profile
STATUS AS OF 10-7-07




Information Infrastructure section—almost
completed…14 persons regularly attended—all
participated in re-writing and voting on assuring
that the profile reflects our industry needs
Direct Care section—moving slowly…16 to 20
persons regularly attend and vote—additional
time will be spent by workgroup members to
carefully review and finish—MEET the challenge!
Supportive Services section—review and vote
will begin shortly—MEET the challenge!!
14-20 persons directing EHR software
functionality for 17,000 SNF’s???
77
Trunk—SDO—
pharmaceutical


“Mission Statement:
NCPDP creates and promotes standards for the transfer
of data to and from the pharmacy services sector of the
healthcare industry. The organization provides a forum
and support wherein our diverse membership can
efficiently and effectively develop and maintain these
standards through a consensus building process.
…a not-for-profit ANSI-accredited Standards
Development Organization.”
From–www.ncpdp.org
Standards for prescription entry, transmission, reconciliation, and fulfillment—
an integral part on an EHR.
78
Trunk—SDO—terminology
 “Systemized Nomenclature of Medicine- SNOMED

…a dynamic, scientifically validated clinical
health care terminology and infrastructure that
makes health care knowledge more usable
and accessible.


SNOMED CT— SNOMED Clinical Terms– provides a common
language that enables a consistent way of capturing, sharing and
aggregating health data across specialties and sites of care.” –
concepts, descriptions, relationships…(from www.snomed.org)
Example: For the concept Pneumonia (disorder), the ConceptID
is 233604007
IHTSDO®
79
•
•
Trunk—SDO—format/terminology
Logical Observation Identifier Names and Codes—LOINC
“LOINC is a voluntary effort housed in the Regenstrief Institute, an
internationally respected non-profit medical research organization
associated with Indiana University. LOINC system was initiated in
1994 by the Regenstrief Institute and developed by Regenstrief and
the LOINC committee as a response to the demand for electronic
movement of clinical data from laboratories that produce the data
to hospitals, physician's offices, and payers who use the data for
clinical care and management purposes.”
(from www.regenstrief.org/loinc)
•LOINC has expanded beyond laboratory; for clinical symptoms and results
•MDS 2.0 has been LOINC’d or LOINCified…
80
Trunk—EHR hardware…
A tablet device—
usually wireless. Very
portable, but has
limited screen size.
81
TRUNK—EHR HARDWARE
Stationary devices,
such as KIOSKS—
can be wall
mounted or
mounted on rolling
table stands.
Staff enters
information near
OR IN patient care
=timely and more
accurate
documentation.
Other hardware, wireless/wired—multiple configurations
82
Branches and growth…
HIE—Health Information Exchange
via
RHIO—Regional Health Information
Organization or
 RHIN—Regional Health Information
Network, and finally a…
 NHIN—National Health Information
Network—CMS has selected vendors which
will be allowed to compete for this
“prize”—Enterprise System Developlent, 10
years, $4 billion

83
As the tree grows, where will you be??
In a “connected” home environment …
with plans for continuing modernization??
Or gathering up the leaves and
paper—hoping for a fire???…
84
WE NEED YOU TO ADVANCE HIT!!
 Visit the “virtual
nursing home” and
technology Halls. Talk
with these vendors
and other experts—be
sure you have
knowledgeable
contacts who will
REMAIN up to date!
 SHARE and
continuously expand
YOUR KNOWLEDGE
 Start your plan NOW!!
85
WE NEED YOU TO ADVANCE HIT!!
 And when you get back
home…
 GET YOUR staff and
FACILITY READY—
cultural change may
prove to be more costly
than actual system
change if not tackled
first
 Don’t do it alone…
 PARTICIPATE AT THE
LOCAL LEVEL
 PARTICIPATE AT THE
NATIONAL LEVEL
86
Thank you for your participation!!
Grateful thanks are given to:
•Health Facilities Association of Maryland and Members of its HIT
committee, and,
•AHCA’s HIT Committee,
•And others…
Who willingly offered their time and expertise to provide ruthless criticism and
constructive suggestions…that’s what friends are for…
This presentation (containing links to organizations and other resources) will be available
on the AHCA Members website shortly after the convention.
Eileen Doll, RN, BS, NHA
Healthcare Consultant
EDHC INC
Nathan Lake, RN, BSN, MSHA
Director, Clinical Design
American HEALTHTECH
[email protected]
[email protected]
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88