Electronic Health Record Certification How Do National Level Programs Reduce the Risk of Purchase Decisions?

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1 Certification Commission for Healthcare Information Technology Electronic Health Record Certification How Do National Level Programs Reduce the Risk of Purchase Decisions? John Tooker, MD, MBA, FACP EVP/CEO, ACP Commissioner, CCHIT Sarah T Corley, MD, FACP Governor, Virginia Chapter, ACP Co-Chair, Functionality Work Group Mark K. Leavitt, MD, PhD Chair, CCHIT Moderator: Mureen Allen, MD Senior Associate, Informatics & Practice Improvement, ACP Presented at ACP Annual Session -- Philadelphia, PA, April 7, 2006

2 Today s Topics Barriers to EHR adoption National initiatives to accelerate EHR adoption Introduction to CCHIT How CCHIT develops criteria and tests EHRs How to learn more or participate Comments from Dr Tooker and Dr Corley Audience Q & A 2006 Slide 2 4/7/06

3 Barriers to EHR Adoption in Ambulatory Care Low penetration of EHR in physician offices 1 Only 14% of practices report EHRs in place Adoption Gap even wider for small practices Barriers to EHR adoption Cost of system Lack of positive financial incentives Risks Risks include Inadequate functionality Implementation failure Product obsolescence / vendor instability Incompatibility with external data sources (not interoperable ) 1 D Gans, J Kralewski, T Hammons, B Dowd, Health Affairs, Sept Slide 3 4/7/06

4 National Initiatives to Accelerate Health IT Adoption January 2004: President Bush calls for computerizing health records in his State of the Union address May 2004: President appoints first National Coordinator for Health IT, David J Brailer, MD, PhD July 2004: HHS Strategic Framework for Health IT released, calling certification of health IT a key action June 2005: HHS RFP issued for Health IT contracts Sept 2005: Contracts awarded: Standards Harmonization Compliance Certification National Health Information Network Prototypes Privacy and Security Solutions 2006 Slide 4 4/7/06

5 Certification Commission for Healthcare Information Technology Introduction to CCHIT

6 Mission To accelerate the adoption of robust, interoperable health IT by creating an efficient, credible and sustainable product certification program Slide 6 4/7/06

7 Guiding Principles Alwaysprotect the privacy of the patient/ consumer s health information Need for decisive private-sector action now Governance must be credible, objective, and collaborative Seek input and deliver compelling value for all key stakeholders Inspection process must be objective, fair, reliable, repeatable Certification must be efficient, timely, and cost-effective 2006 Slide 7 4/7/06

8 Stakeholders Private Sector Physicians and other providers Vendors Payers/purchasers Consumers Quality Improvement Researchers Standards Developers HHS/ONC Public Sector HHS Contractors Safety Net Providers Public Health Federal agencies NIST, DoD, VHA, DHS, DoC, NSF, GSA, EPA and others 2006 Slide 8 4/7/06

9 Goals of EHR Product Certification Reduce the risks of purchase and implementation of EHRs Facilitate interoperability of EHRs within the emerging national health information network Enhance availability of EHR adoption incentives and relief of regulatory barriers Ensure that EHR products and networks always protect the privacy of personal health information 2006 Slide 9 4/7/06

10 Product Certification as a Catalyst to EHR Adoption Payers/Purchasers: Enhanced quality & efficiency gains from EHR -- unlocking incentives EHR Vendors: Growing market & faster sales cycles -- lowering costs and attracting investment Physicians: Reduced risk, assured compatibility & financial incentives -- accelerating adoption 2006 Slide 10 4/7/06

11 Standards and Certification: Creating a Tipping Point for New Technologies The IBM-PC standard accelerated the personal computing revolution The Ethernet standard made networking easier The Wi-Fi standard made networking (almost) ubiquitous 2006 Slide 11 4/7/06

12 CCHIT Role within HHS Health IT Strategy American Health Information Community Chaired by HHS Secretary Mike Leavitt Office of the National Coordinator Project Officers Standards Harmonization Contractor NHIN Prototype Contractors Privacy/Security Solutions Contractor Harmonized Standards Network Architecture Privacy Policies Strategic Direction CCHIT: Compliance Certification Contractor Certification Criteria + Inspection Process for EHRs and Networks Governance and Consensus Process Engaging Public and Private Sector Stakeholders Accelerated adoption of robust, interoperable, privacy-enhancing health IT 2006 Slide 12 4/7/06

13 Certification Commission for Healthcare Information Technology How CCHIT Develops Criteria and Tests EHRs

14 CCHIT Organization 2006 Slide 14 4/7/06

15 Board of Commissioners Mark Leavitt, MD, PhD Chair, CCHIT Abha Agrawal, MD Director, Medical Informatics Kings County Hospital Stephen Badger Chief Executive Officer GWU Medical Faculty Associates David W. Bates, MD, MSc Chief, General Medicine Brigham and Women s Hospital Karen M. Bell, MD Director, Office of HIT Adoption ONCHIT Bruce Nedrow (Ned) Calonge, MD Chief Medical Officer Colo. Dept of Public Health & Environment Herb Kuhn Office of the Administrator CMS Suzanne Delbanco Executive Director The Leapfrog Group Jane L. Delgado, PhD, MS President and CEO National Alliance for Hispanic Health John Hummel Corporate CIO & Senior VP of IS Sutter Health Sam Karp Chief Program Officer California HealthCare Foundation 2006 Slide 15 4/7/06

16 Board of Commissioners (continued) Charles Kennedy, MD VP of Clinical Informatics WellPoint Health Networks Inc. Graham O. King President, IT Business McKesson Information Solutions Jane B. Metzger Vice President First Consulting Group Susan R. Miller, RN, FACMPE Administrator Family Practice Assoc. of Lexington, KY Susan N. Postal, MBA, RHIA Vice President, HIM Services Hospital Corporation of America Wes Rishel Research Director Gartner, Inc. John Tooker, MD, MBA, FACP Executive Vice President / CEO American College of Physicians Reed V. Tuckson, MD Senior VP, Consumer Health United Health Group Andrew G. Ury, MD Chief Executive Officer Physician Micro Systems, Inc Slide 16 4/7/06

17 Workgroups Functionality Co-Chair: Sarah T. Corley, MD, Governor, Virginia Chapter, American College of Physicians Co-Chair: David Kates, MSEE, MBA, COO, Hx Technologies, Inc Vincent E. Kerr, MD, President, Care Solutions, Uniprise Lynne A. King, RN, BS, MBA, Division Information Officer, Clinical Informatics, University Hospital Health System Steven R. Lane, MD, MPH, FAAFP, Clinical Lead, Ambulatory EHR, Sutter Health, Medical Director, HIM, Sutter, Palo Alto Med. Found. Eugenia Marcus, MD, American Academy of Pediatrics Eric Rose, MD, Product Manager, Physician Micro Systems, Inc. Todd R. Rowland, MD, Director of Medical Informatics, Bloomington Hospital and Healthcare System Khiang C. Seow, Director of Software Development - Clinical Enterprise Products and Care Everywhere, Epic Systems Corporation Steven J. Steindel, PhD, Sr Advisor Data Stds Vocab, CDC David L. Winn, MD, CEO, President and Founder, e-mds Inc. Interoperability Co-Chair: Peter J. DeVault, Director of Enterprise Integration and Interoperability, Epic Systems Corporation Co-Chair: Carol C. Diamond, MD, MPH, Managing Director, Health Program, Markle Foundation Richard Elmore, Vice President, IDX Systems Corporation Mary Hall Gregg, PhD, VP Clinical Information Solutions, Quest Diagnostics Patricia L. Hale, MD, PhD, FACP, CMIO, Glen Falls Hospital David C. Kibbe, MD, Director Center for Health Information Technology, American Academy of Family Physicians Ronald A. Paulus, MD, MBA, Chief HIT Officer & Special Assistant to the President/CEO, Geisinger Health System Kent A. Spackman MD, PhD, Professor, Oregon Health & Science University David K. Tao, DSc, IT Architect, Siemens Medical Solutions Health Services Alan E. Zuckerman, MD, Primary Care Informatics Program Director, Georgetown University 2006 Slide 17 4/7/06

18 Workgroups (continued) Security & Reliability Co-Chair: Solomon I. Appavu, Director Systems Planning, John H. Stroger, Jr. Hospital & Cook County Bureau of Health Services Co-Chair: John F. Moehrke, BS CS&E, Enterprise Security Architect, GE Healthcare Daniel S. Bormann, BA, MS, Chief Security Officer, Epic Systems Corporation Rita K. Bowen, MA, RHIA, CHPS, Chief Privacy Officer/HIM/UR Dir, Erlanger Health System Edward J. Coyne, PhD, MA, BS, Security Architect, Veterans Health Administration John A. Gildersleeve, BA, System Privacy Officer, Geisinger Health System Joseph C. Gilfus, BSBA, MBA, Project Manager, Blue Cross Blue Shield of Florida, Inc. Glen F. Marshall, BBA, IT Architect, Siemens Medical Solutions Marian E. Reed, Corporate Director, Product Security, McKesson Corporation Certification Process Co-Chair: Steve Arnold, MD, MS, CPE, President & CEO, Healthcare Consultants International Co-Chair: Michael L. Kappel, Sr. VP - Government Strategy and Relations, McKesson Corporation Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS, Independent Consultant John C. Durham, MD, Vice President and Chief Medical Officer, Greenway Medical Technologies Gerry Hinckley, Partner, Davis Wright Tremaine LLP Linda L. Hogan, PhD, Director, Medical Informatics & Clinical Transformation, Catholic Health East Dan S. Michelson, MBA, Chief Marketing Officer, Allscripts Healthcare Solutions Joseph H. Schneider, MD, MBA, CMIO, Children's Medical Center Robert M. Tennant, MA, Senior Policy Advisor, Health Informatics, Medical Group Management Association Use Case / Test Plan (comprised of members from the other Workgroups) Co-Chair: Marian E. Reed Co-Chair: Steve Arnold, MD, MS, CPE Edward J. Coyne, PhD, MA, BS Peter J. DeVault Eugenia Marcus, MD Solomon I. Appavu Steven J. Steindel, PhD Robert M. Tennant, MA David L. Winn, MD Alan Zuckerman, MD 2006 Slide 18 4/7/06

19 Scope of Work Under HHS Contract Phase I (Oct 05 Sep 06) Develop, pilot test, and assess certification of EHR products for ambulatory care settings Phase II (Oct 06 Sep 07) Develop, pilot test, and assess certification of EHR products for inpatient care settings Phase III (Oct 07 Sep 08) Develop, pilot test, and assess certification of infrastructure or network components through which EHRs interoperate 2006 Slide 19 4/7/06

20 Timeline Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Develop, publish proposed criteria and test plan Pilot test and publish report Final comments, begin certification Phase I: Ambulatory EHR Each Phase includes at least two cycles of public comment during development plus one cycle after pilot test Develop, publish proposed criteria Develop, publish proposed test plan Pilot test and publish report Final comments, begin certification Phase II: Inpatient EHR Not shown: criteria for each domain are updated annually after initial development Phase III: Networks Develop, publish proposed criteria Develop, publish proposed test plan Pilot test & publish report Final comments, begin certification 2006 Slide 20 4/7/06

21 Functionality Criteria for 2006: Highlights Maintain patient demographic data and identifiers Manage problem list Manage medication list Manage allergy/adverse reaction list Manage patient history (basic) Display/print summary health record Capture clinical documents/notes Capture external documents Generate patient-specific instructions Create prescriptions Order diagnostic tests Manage results (basic) Manage consents and authorizations (basic) Manage advance directives (basic) Care plans (basic) Drug interaction checking Medication and immunization administration (basic) Alerts for disease management, prevention, wellness Reminders and notifications Task assignment and routing Inter-provider communication Provider database of access levels Scheduling (basic - display from external system) Report generation (basic) Health record output (basic) Encounter management (basic) Coding assistance (basic) Concurrent access to the record 2006 Slide 21 4/7/06

22 Testing EHR Products Vendors apply and pay testing fee Jury panel observes a rigorously supervised product demonstration At least one practicing physician Two additional clinicians IT/Security expert Test proctor Over 250 test steps 100% compliance with criteria is required First batch of certified products expected June/July 2006 will be announced in press and on CCHIT website 2006 Slide 22 4/7/06

23 Opportunities for Participation View all of our work -- criteria and test procedures, meeting minutes, and presentations -- at Sign up on website to receive enews from CCHIT Town Halls, Town Calls, and booths at physician conferences and other outreach events Public comment periods on draft and final criteria Volunteer to serve on a Workgroup Serve as a Juror Serve on the Commission Nominations will open this summer 2006 Slide 23 4/7/06

24 Certification Commission for Healthcare Information Technology Comments from our Panelists: John Tooker, MD, MBA, FACP EVP/CEO, ACP Commissioner, CCHIT Sarah T Corley, MD, FACP Governor, Virginia Chapter, ACP Co-Chair, CCHIT Functionality Work Group

25 Thank You! Q & A For more information:

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